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. 2022 Feb 1;50(2):e129-e142.
doi: 10.1097/CCM.0000000000005271.

Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm: A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial

Eva M Spoormans  1 , Jorrit S Lemkes  1 , Gladys N Janssens  1 , Nina W van der Hoeven  1 , Lucia S D Jewbali  2 , Eric A Dubois  2   3 , Martijn Meuwissen  4 , Tom A Rijpstra  5 , Hans A Bosker  6 , Michiel J Blans  7 , Gabe B Bleeker  8 , Remon Baak  9 , Georgios J Vlachojannis  10   11 , Bob J W Eikemans  12 , Armand R J Girbes  13 , Pim van der Harst  14   15 , Iwan C C van der Horst  11   16 , Michiel Voskuil  15 , Joris J van der Heijden  17 , Albertus Beishuizen  18 , Martin Stoel  19 , Cyril Camaro  20 , Hans van der Hoeven  21 , José P Henriques  22 , Alexander P J Vlaar  23 , Maarten A Vink  24 , Bas van den Bogaard  25 , Ton A C M Heestermans  26 , Wouter de Ruijter  27 , Thijs S R Delnoij  16 , Harry J G M Crijns  28 , Gillian A J Jessurun  29 , Pranobe V Oemrawsingh  30 , Marcel T M Gosselink  31 , Koos Plomp  32 , Michael Magro  33 , Peter M van de Ven  34 , Niels van Royen  1   20 , Paul W G Elbers  13
Affiliations

Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm: A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial

Eva M Spoormans et al. Crit Care Med. .

Abstract

Objectives: The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and 36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.

Design: Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.

Setting: Nineteen hospitals in The Netherlands.

Patients: The Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0-34.0°C) or targeted normothermia (36.0-37.0°C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician.

Interventions: None.

Measurements and main results: After 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 [95% CI, 0.62-1.18]; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45-1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d [3-7 d] vs 3 d [2-5 d]; ratio of geometric means, 1.32; 95% CI, 1.15-1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups.

Conclusions: In the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.

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Conflict of interest statement

Dr. Lemkes received funding from The Netherlands Heart Institute (NHLI) and Biotronik. Drs. Lemkes and Vlachojannis received funding from AstraZeneca. Dr. Rijpstra’s institution received funding from Principle Investigator. Dr. Vlachojannis’ institution received funding from MicroPort and Daiichi Sankyo; he received funding from Abbott. Dr. Vlachojannis reports receiving grant support from MicroPort Orthopedics and Daiichi Sankyo. Dr. van Royen’s institution received funding from Biotronik, AstraZeneca, the NHLI, Abbott, and Medtronic; he received funding from Novartis, MicroPort, Castor, Rainmed, Biotronik, Abbott, Medtronic, and Philips; he received support for article research from the NLHI. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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