Abstract 12326: Optimal Targeted Temperature in Comatose Survivors After Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation
Introduction: Even after the report of the Targeted Temperature Management trial, optimal targeted temperature (TT) in targeted temperature management for comatose survivors after cardiac arrest is still controversial.
Hypothesis: We assessed the hypothesis that lower TT provides improved outcomes in patients after cardiac arrest.
Methods: Adult comatose survivors of cardiac arrest without obvious extra-cardiac causes and treated with targeted temperature management were enrolled in this study. We assessed the association between TTs, and favorable outcomes. We divided the study patients into 2 groups according to TT < 34°C (33°C group) or not (34°C group). Favorable outcomes were defined as 90-day cerebral performance category of 1 or 2. P < 0.05 was defined as statistically significant.
Results: Among all the study patients (N = 221), there were no significant differences in age, sex, rate of initial shockable rhythms, bystander initiated cardiopulmonary resuscitation (CPR), time interval from collapse to return of spontaneous circulation between the patients of 33°C group and that of 34°C groups. The rate of performing extracorporeal CPR (ECPR) using venoarterial extracorporeal membrane oxygenation were higher in the patients of 33°C group than that of 34°C group (81% vs. 42%, P < 0.01). The rates of favorable outcomes were similar between the 2 groups (41% vs 34%, P = 0.34). In the patients treated with conventional CPR (N = 142), the rates of favorable outcomes were similar between the 2 groups (54% vs. 46%, P = 0.38). However, in the patients who were unresponsive to conventional CPR and treated with ECPR (N = 79), the rates of favorable outcomes were higher in the patients of 33°C group than that of 34°C group (28% vs. 5%, P < 0.01).
Conclusions: TT of 34°C to 36°C may be reasonable for patients treated with conventional CPR. In patients who were unresponsive to conventional CPR and treated with ECPR, TT < 34°C may be superior to TT of 34°C.
- Therapeutic hypothermia
- Cardiac arrest
- Cardiopulmonary resuscitation
- Extracorporeal circulation
Author Disclosures: E. Kagawa: None. K. Dote: None. M. Kato: None. S. Sasaki: None. N. Oda: None. Y. Nakano: None. Y. Kihara: None.
- © 2014 by American Heart Association, Inc.