Optimal Targeted Temperature Management for Patients with Post-Cardiac Arrest Syndrome

Abstract

Background: To prevent hypoxic-ischemic brain damage in patients with post-cardiac arrest syndrome (PCAS), international guidelines have emphasized performing targeted temperature management (TTM). However, the most optimal targeted core temperature and cooling duration reached no consensus to date. This study aimed to clarify the optimal targeted core temperature and cooling duration, selected according to the time interval from collapse to return of spontaneous circulation (ROSC) in patients with PCAS due to cardiac etiology. Methods: Between 2014 and 2020, the targeted core temperature was 34 °C or 35 °C, and the cooling duration was 24 h. If the time interval from collapse to ROSC was within 20 min, we performed the 35 °C targeted core temperature (Group A), and, if not, we performed the 34 °C targeted core temperature (Group B). Between 2009 and 2013, the targeted core temperature was 34 °C, and the cooling duration was 24 or 48 h. If the interval was within 20 min, we performed the 24 h cooling duration (Group C), and, if not, we performed the 48 h cooling duration (Group D). Results: The favorable neurological outcome rates at 30 days following cardiac arrest were 45.7% and 45.5% in Groups A + B and C + D, respectively (p = 0.977). In patients with ROSC within 20 min, the favorable neurological outcome rates at 30 days following cardiac arrest were 75.6% and 86.4% in Groups A and C, respectively (p = 0.315). In patients with ROSC ≥ 21 min, the favorable neurological outcome rates at 30 days following cardiac arrest were 29.3% and 18.2% in Groups B and D, respectively (p = 0.233). Conclusions: Selecting the optimal target core temperature and the cooling duration for TTM, according to the time interval from collapse to ROSC, may be helpful in patients with PCAS due to cardiac etiology.

Keywords: post-cardiac arrest syndrome; resuscitation; targeted temperature management; therapeutic hypothermia.

Figure 1

Therapeutic hypothermia protocols from January 2014 to December 2020. CAG indicates coronary angiography; PCI, percutaneous coronary intervention. (A) When the time interval from collapse to the return of spontaneous circulation (ROSC) was within 20 min, we performed the 35 °C targeted core temperature, and the cooling duration was 24 h (Group A). (B) When the interval was not within 20 min, we performed the 34 °C targeted core temperature, and the cooling duration was 24 h (Group B).

Figure 2

Therapeutic hypothermia protocols from January 2009 to December 2013. CAG indicates coronary angiography; PCI, percutaneous coronary intervention. (A) When the time interval from collapse to the return of spontaneous circulation (ROSC) was within 20 min, we performed the 34 °C targeted core temperature, and the cooling duration was 24 h (Group C). (B) When the interval was not within 20 min, we performed the 34 °C targeted core temperature, and the cooling duration was 48 h (Group D).

Figure 3

Study profile. ROSC indicates return of spontaneous circulation; CCU, cardiac care unit.

Figure 4

Primary outcomes. (A) Whole cohort, (B) return of spontaneous circulation (ROSC) within 20 min, and (C) ROSC ≥ 21 min.

Figure 5

T The favorable 30-day neurological outcomes on the basis of the time interval from collapse to return of spontaneous circulation (within 20 min, 21–30 min, and ≥31 min).