Abstract 165: Impact of Fever on Neurologic Outcome in Patients Undergoing Therapeutic Hypothermia Post Cardiac Arrest
Introduction: Therapeutic hypothermia (TH) is thought to increase the rate of neurologic recovery after resuscitation from cardiac arrest. Recent evidence demonstrates that TH may be less significant than avoiding hyperthermia in preventing neurologic damage. The aim of this study is to review patients who underwent TH as a part of post cardiac arrest care and examine whether being febrile at a certain time point (i.e. 0-24hr, 24-48hr, 48-72hr) was associated with worse neurologic outcome.
Methods: This is a retrospective analysis of 46 patients who underwent hypothermia protocol between 2008 and 2014 in the cardiac intensive care unit at a tertiary care center. Patients who were suitable for TH were cooled to maintain a target body temperature of 34° for 24 hours after return of spontaneous circulation (ROSC). Data collected through chart review included medical history, initial rhythm, disposition, temperature up to 72 hours post arrest, and cerebral performance category score (CPC) at discharge. Favorable CPC was defined as 1-2 whereas unfavorable was defined as 3-5. The primary outcome of this study was neurologic function quantified by the CPC score. A logistic regression model was used to determine the relationship between fever and CPC.
Results: Within the cohort, 22 patients (48%) developed fever within 72 hours and 24 remained afebrile. There was a significant overall effect of fever timing (p=0.028), with the odds of favorable CPC significantly lower in all fever time points than in the reference category of no fever. Odds ratios between 0-24, 24-48, and 48-72 hours were not significant (p=0.671, 0.6721, and 0.954, respectively). Patients with fever at any time within 72 hours were significantly less likely to have a favorable CPC than those with no fever. People with no fever had 12.5 times the odds of a favorable CPC score than those with fever (OR =0.08, 95% CI (0.02, 0.37), p =0.001).
Conclusions: Fever up to 72 hours post cardiac arrest is associated with poor neurologic outcomes. There was no significant difference in neurologic outcome between the different time groups, however patients with no fever had better neurologic outcome within each group.
- Cardiac arrest
- Return of spontaneous circulation (ROSC)
- Therapeutic hypothermia
Author Disclosures: P.U. Thanawala: None. N. Fonseka: None. G. Marhefka: None.
- © 2014 by American Heart Association, Inc.