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Lyden P, Kapinos G, Sekhon MS, Levi AD. Temperature Management in Neurological and Neurosurgical Intensive Care Unit. Ther Hypothermia Temp Manag 2020; 10:86-90. [PMID: 32326850 DOI: 10.1089/ther.2020.29072.pjl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Patrick Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gregory Kapinos
- Department of Neurology, SUNY Downstate College of Medicine, New York, New York, USA
| | - Mypinder S Sekhon
- Division of Critical Care Medicine, Vancouver General Hospital of British Columbia, Vancouver, Canada
| | - Allan D Levi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Johnsson J, Wahlström J, Dankiewicz J, Annborn M, Agarwal S, Dupont A, Forsberg S, Friberg H, Hand R, Hirsch KG, May T, McPherson JA, Mooney MR, Patel N, Riker RR, Stammet P, Søreide E, Seder DB, Nielsen N. Functional outcomes associated with varying levels of targeted temperature management after out-of-hospital cardiac arrest - An INTCAR2 registry analysis. Resuscitation 2019; 146:229-236. [PMID: 31706964 DOI: 10.1016/j.resuscitation.2019.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) has been recommended in international guidelines since 2005. The TTM-trial published in 2013 showed no difference in survival or neurological outcome for patients randomised to 33 °C or 36 °C, and many hospitals have changed practice. The optimal utilization of TTM is still debated. This study aimed to analyse if a difference in temperature goal was associated with outcome in an unselected international registry population. METHODS This is a retrospective observational study based on a prospective registry - the International Cardiac Arrest Registry 2. Patients were categorized as receiving TTM in the lower range at 32-34 °C (TTM-low) or at 35-37 °C (TTM-high). Primary outcome was good functional status defined as cerebral performance category (CPC) of 1-2 at hospital discharge and secondary outcome was adverse events related to TTM. A logistic regression model was created to evaluate the independent effect of temperature by correcting for clinical and demographic factors associated with outcome. RESULTS Of 1710 patients included, 1242 (72,6%) received TTM-low and 468 (27,4%) TTM-high. In patients receiving TTM-low, 31.3% survived with good outcome compared to 28.8% in the TTM-high group. There was no significant association between temperature and outcome (p = 0.352). In analyses adjusted for baseline differences the OR for a good outcome with TTM-low was 1.27, 95% CI (0.94-1.73). Haemodynamic instability leading to discontinuation of TTM was more common in TTM-low. CONCLUSIONS No significant difference in functional outcome at hospital discharge was found in patients receiving lower- versus higher targeted temperature management.
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Affiliation(s)
- Jesper Johnsson
- Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
| | | | - Josef Dankiewicz
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Martin Annborn
- Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sachin Agarwal
- Department of Neurology, Columbia University Medical Center, New York City, United States
| | - Allison Dupont
- Department of Cardiology, Eastern Georgia, United States
| | - Sune Forsberg
- Department of Intensive Care, Norrtälje Hospital, Center for Resuscitation Science, Karolinska Institute, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Lund University, Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | - Robert Hand
- Department of Medical Services, Eastern Maine Medical Center, United States
| | - Karen G Hirsch
- Department of Neurology, Stanford University, United States
| | - Teresa May
- Department of Critical Care Services, Maine Medical Center, Portland, ME, United States
| | | | - Michael R Mooney
- Minneapolis Heart Institute, Abbott North-Western Hospital, United States
| | - Nainesh Patel
- Department of Cardiology, Lehigh Valley Health Network, PA, United States
| | - Richard R Riker
- Department of Critical Care Services, Maine Medical Center, Portland, ME, United States
| | - Pascal Stammet
- Medical and Health Department, National Fire and Rescue Corps, Luxembourg
| | - Eldar Søreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, ME, United States
| | - Niklas Nielsen
- Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
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Nichol G, Polderman KH, Friberg H, Kurz M, Kapinos G. Perspectives on Temperature Management. Ther Hypothermia Temp Manag 2018; 8:188-194. [DOI: 10.1089/ther.2018.29052.gjn] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Division of Internal Medicine, Seattle, Washington
| | - Kees H. Polderman
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Hans Friberg
- Department of Emergency Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Michael Kurz
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory Kapinos
- Departments of Neurology, Neurosurgery and Emergency Medicine, Kings County Hospital/SUNY Downstate College of Medicine, Brooklyn, New York
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