TY - JOUR
T1 - Increased protocol adherence and safety during controlled normothermia as compared to hypothermia after cardiac arrest
AU - Düggelin, Ramona
AU - Maggiorini, Marco
AU - Voigtsberger, Stefanie
AU - Schwarz, Urs
AU - Hilty, Matthias P.
N1 - Publisher Copyright: © 2020
PY - 2021/6
Y1 - 2021/6
N2 - Purpose: This study aims to compare protocol adherence, neurological outcome and adverse effects associated with a controlled hypothermia versus a controlled normothermia protocol in patients successfully resuscitated after cardiac arrest. Methods: In this retrospective single-center study in a university intensive care unit in Switzerland, post-cardiac arrest patients were compared before and after a protocol change from targeted temperature management at 33 °C (TTM-33) to 36 °C (TTM-36) using an intravascular cooling device. Protocol adherence was assessed as the primary outcome. Secondary outcomes were in-hospital mortality, neurological outcome and adverse effects. Results: 373 patients after cardiac arrest were screened, of whom a total of 133 patients were included. Protocol adherence was lower in the TTM-33 group (47% vs 87% of patients, p < 0.01). In-hospital mortality (59% vs 45%, p = 0.15) and neurological outcome (modified Rankin Score < 4 in 33% vs 39% and CPC-Score < 3 in 33% vs 39% of patients, p = 0.60 and 0.97) were similar. Overall incidence of adverse effects was comparable, with bradycardic arrhythmias occurring more frequently in the TTM-33 group. Conclusion: Protocol adherence was higher in the TTM-36 group. In-hospital mortality and neurological outcome were similar, while bradycardic arrhythmias were encountered more often in TTM-33.
AB - Purpose: This study aims to compare protocol adherence, neurological outcome and adverse effects associated with a controlled hypothermia versus a controlled normothermia protocol in patients successfully resuscitated after cardiac arrest. Methods: In this retrospective single-center study in a university intensive care unit in Switzerland, post-cardiac arrest patients were compared before and after a protocol change from targeted temperature management at 33 °C (TTM-33) to 36 °C (TTM-36) using an intravascular cooling device. Protocol adherence was assessed as the primary outcome. Secondary outcomes were in-hospital mortality, neurological outcome and adverse effects. Results: 373 patients after cardiac arrest were screened, of whom a total of 133 patients were included. Protocol adherence was lower in the TTM-33 group (47% vs 87% of patients, p < 0.01). In-hospital mortality (59% vs 45%, p = 0.15) and neurological outcome (modified Rankin Score < 4 in 33% vs 39% and CPC-Score < 3 in 33% vs 39% of patients, p = 0.60 and 0.97) were similar. Overall incidence of adverse effects was comparable, with bradycardic arrhythmias occurring more frequently in the TTM-33 group. Conclusion: Protocol adherence was higher in the TTM-36 group. In-hospital mortality and neurological outcome were similar, while bradycardic arrhythmias were encountered more often in TTM-33.
KW - Cardiac arrest
KW - Hypothermia
KW - Neurological outcome
KW - Resuscitation
KW - Temperature
UR - http://www.scopus.com/inward/record.url?scp=85091684614&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2020.09.019
DO - https://doi.org/10.1016/j.jcrc.2020.09.019
M3 - Article
C2 - 32998828
SN - 0883-9441
VL - 63
SP - 146
EP - 153
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -