Abstract 322: Report of Adverse Effects From a U.S. Registry of Patients Undergoing Targeted Temperature Management Following Cardiac Arrest
Background: Targeted temperature management (TTM) has been shown to improve outcomes following resuscitation from cardiac arrest. Registry studies from Europe have illustrated an array of potential adverse effects (AEs) from post-arrest cooling, however the broad experience of US hospitals with regard to TTM-associated AEs has not been described.
Objective: To identify incidence of AEs reported in a multicenter US registry of post-arrest patients treated with TTM.
Methods: Retrospective chart review of post-arrest patients from 14 US hospitals who were treated with TTM and enrolled into the Penn Alliance for Therapeutic Hypothermia data registry (PATH).
Results: A total of 675 patients received TTM after cardiac arrest between 1/2005 - 3/2013. Mean age was 59.3±15 yrs, 279/675 (41%) were female and 229/675 (34%) had shockable rhythms. Mean TTM duration was 24.7±9.8 hrs and rewarming duration of 14.3±7.9 hrs. Survival to hospital discharge occurred in 265/666 (40% - data missing in 9 patients); in survivors, 214/265 (81%) manifested Cerebral Performance Category scores of 1 or 2. Data on seizure activity were available for 359/675 patients (53%); 60/359 (17%) manifested seizure/myoclonus clinically or on EEG. AE data associated with the TTM process were available for 316/675 (47%) patients and not documented for 359 (53%). Hyperglycemia (> 144 mg/dL glucose at ≥1 time points during TTM maintenance) was prevalent and reported in 251/316 (79%) patients. Of 316 patients, 157 (50%) described other specific AEs. Shivering was noted in 78/316 (25%) patients, treated most often by meperidine 38/78 (49%) or neuromuscular blockade 34/78 (44%). Fever occurred in 40/316 (13%) patients and dysrhythmias in 19/316 (6%). Three of 19 patients suffered re-arrest during TTM; one re-arrest patient was below target temperature (32-34o C). Hypokalemia was reported in 15/316 (5%) and hyperkalemia in 4/316 (1%) patients. Skin breakdown was specified in 15/316 (5%), bleeding in 8/316 (3%) patients- 3 requiring transfusion - and pneumonia in 7/316 (2%).
Conclusions: In this patient cohort enrolled in a US post-arrest care registry, incidence of AEs is comparable to previous reports. Specifically, bleeding complications were infrequent and comparable to non-US studies.
- © 2013 by American Heart Association, Inc.