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. 2023 Dec 21:17:100538.
doi: 10.1016/j.resplu.2023.100538. eCollection 2024 Mar.

Comparative before-after study of fever prevention versus targeted temperature management following out-of-hospital cardiac arrest

P Leadbeater  1   2 , A Warren  1   3   4 , E Adekunle  1 , H Fielden  5 , J Barry  1 , A G Proudfoot  1   4
Affiliations

Comparative before-after study of fever prevention versus targeted temperature management following out-of-hospital cardiac arrest

P Leadbeater et al. Resusc Plus. .

Abstract

Background: International guidelines for neuroprotection following out-of-hospital cardiac arrest (OHCA) recommend fever prevention ahead of routine temperature management. This study aimed to identify any effect of changing from targeted temperature management to fever prevention on neurological outcome following OHCA.

Methods: A retrospective observational cohort study was conducted of consecutive admissions to an ICU at a tertiary OHCA centre. Comparison was made between a period of protocolised targeted temperature management (TTM) to 36 °C and a period of fever prevention.

Results: Data were available for 183 patients. Active temperature management was administered in 86/118 (72%) of the TTM cohort and 20/65 (31%) of the fever prevention group. The median highest temperature prior to the start of temperature management was significantly lower in the TTM group at 35.6 (IQR 34.9-36.2) compared to 37.9 °C (IQR 37.7-38.2) in the fever prevention group (adjusted p < 0.001).There was no difference in the proportion of patients discharged with Cerebral Performance Category 1 or 2 between the groups (42% vs. 40%, p = 0.88). Patients in the fever prevention group required a reduced duration of noradrenaline (36 vs. 46 h, p = 0.03) and a trend towards a reduced duration of propofol (37 vs. 56 h, p = 0.06).In unadjusted analysis, use of active temperature management (irrespective of group) appeared to be associated with decreased risk of poor outcome (OR = 0.43, 95% CI 0.23-0.78) but after adjustment for patient age, presenting rhythm, witnessed arrest and duration of CPR, this was no longer significant (OR = 0.93, 95% CI 0.37-2.31, p = 0.88).

Conclusion: Switching from TTM to fever prevention following OHCA was associated with similar rates of neurological outcomes, with a possible decrease in sedation and vasopressor requirements.

Keywords: Neuroprognostication; Out-of-Hospital Cardiac Arrest; Targeted temperature management; Therapeutic Hypothermia.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [AP is funded by a Medical Research Council Clinical Academic Research Partnership Award (Ref:MR/W03011X/1) and the Barts Charity. All other authors declare no conflict of interest.].

Figures

Fig. 1
Fig. 1
Distribution of post-admission temperature in the first 72 h post ICU admission from 148 patients admitted to ICU after out-of-hospital cardiac arrest. Summary of mean temperature over 4 hour periods post-ICU admission. FP = Fever Prevention; TTM = Targeted Temperature Management.
Fig. 2
Fig. 2
Rolling median temperature across 4-hour intervals for patients admitted to ICU post cardiac arrest stratified by temperature management protocol and actual device use.
See this image and copyright information in PMC

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