Abstract 225: Incidence, Timing and Effect of Fever on Outcomes Following Resuscitation from Cardiac Arrest
Fever after cardiac arrest is associated with poor outcomes. We hypothesized that the association of fever and outcome would differ between patients treated with therapeutic hypothermia (TH) and those not.
We included 338 comatose patients who survived >48 hours after admission to a single center between 1/1/2005 and 6/30/2010. Fever was defined as T≥ 38.0°C within 48 hours of arrest. Categories of post-cardiac arrest illness severity were defined by neurological examination and sequential organ failure assessment (SOFA) score on presentation: 1) awake, 2) coma (not following commands but intact brainstem responses) + mild cardiopulmonary dysfunction (SOFA cardiac + respiratory score <4), 3) coma + moderate-severe cardiopulmonary dysfunction (SOFA cardiac + respiratory score >=4), and 4) coma without brainstem reflexes. Logistic regression measured association of fever and clinical variables with survival and good outcome (discharge to home or to acute rehabilitation facility).
Mean age was 60 years (SD 16), 212(63%) had out-of-hospital cardiac arrest (OHCA), and 220 (65%) received TH. Ventricular fibrillation/ventricular tachycardia (VF/VT) was the primary rhythm for 133 (40%). Post arrest illness severity was category II in 119 (38%) , category III in 62 (20%), and category IV in 133 (42%). One hundred twenty eight (38%) survived; 75 (22%) with good outcomes. Fever was present in 142 (42%) of patients, with a median onset of 15 hours post-arrest in the non-TH cohort and 36 hours in TH cohort. Survival was associated with VF/VT (OR 2.60, CI 1.56-4.32) and category IV (OR 0.15, CI 0.08-0.27). Good outcome was associated with OHCA (OR 4.08, CI 1.99-8.39) and category IV (OR 0.13, CI 0.06-0.27). Fever was not associated with survival (OR 0.99, CI 0.57;1.70) or good outcome (OR 0.90, CI 0.47; 1.75) overall. Fever was negatively associated with survival in non-TH cohort (OR 0.38, CI 0.17;0.84) but not within the TH cohort (OR 1.48, CI 0.73; 2.97). Fever was not associated with good outcomes in the TH cohort (OR 1.34, CI 0.59; 3.06) or non-TH cohort (OR 0.36, 0.11; 1.13).
Fever is common in both TH and non-TH patients. Onset time is later after TH. Fever is negatively associated with survival in non-TH patients but not in TH patients.
- © 2012 by American Heart Association, Inc.