Abstract 16687: Pyrexia After Hypothermia in Cardiac Arrest Patients is Associated With Increased Mortality
Background: Post-cardiac arrest fever has been associated with adverse outcome before implementation of therapeutic hypothermia (TH), however the prognostic implications of post-hypothermia pyrexia (PHP) in the era of modern post-resuscitation care has not been thoroughly investigated.
This study reports a tertiary single heart centre experience on the association between PHP and outcome in consecutive comatose survivors after out-of-hospital cardiac arrest (OHCA) treated with TH.
Methods and Results: In the period 2004-2010, a total of 270 patients resuscitated after OHCA and surviving a 24-hour protocol of TH with a target temperature of 32-34°C were included. The population was stratified in two groups by the median peak temperature (≥38.5°C) within 36 hours after rewarming: PHP and no-PHP. Primary endpoint was 30-days mortality and secondary endpoint was neurological outcome assessed by Cerebral Performance Category (CPC) at hospital discharge. Follow-up was complete in all patients.
Baseline demographic and clinical data showed no significant differences between the PHP and no-PHP groups. Development of PHP (≥38.5°C) was associated with a 36% 30-days mortality rate compared to 22% in patients without PHP, plog-rank=0.02, corresponding to an adjusted hazard rate (HR) of 1.8 (95% CI: 1.1-2.7), p=0.02). The maximum temperature (HR=2.0 per °C above 36.5°C (95% CI: 1.4-3.0), p=0.0005) and the duration of PHP (HR=1.6 per 8 hours (95% CI: 1.3-2.0), p<0.0001) within 36 hours after rewarming were independent predictors of 30-days mortality in multivariable models. Gender, age, initial rhythm, bystander CPR and time to ROSC were not associated with development of PHP. Unfavourable outcome (CPC3-5) at hospital discharge was found in 39% vs. 25%, p=0.02, in the PHP group vs. the no-PHP group, respectively.
Conclusions: Post-hypothermia pyrexia ≥38.5°C was associated with increased 30-days mortality, even after adjusting for potential confounding factors. Avoiding pyrexia as a therapeutic target for improving outcome should be evaluated in prospective randomized trials.
- © 2013 by American Heart Association, Inc.