Abstract 270: Targeted Temperature Management at 33 or 36 Degrees in Patients Resuscitated from Out-of-Hospital Cardiac Arrest with Initial Nonshockable Rhythms: Impact on Early Risk Factors
OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality - especially with an initial non-shockable rhythm (NSR). A number of risk factors are traditionally associated with poor outcome in patients with return of spontaneous circulation (ROSC) after OHCA.
HYPOTHESIS: Prognostic information of traditional risk factors remains unaltered in relation to target temperature management of 33°C or 36°C in patients resuscitated from NSR.
METHODS: The Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM) trial reported similar mortality when targeting 33°C (TTM33) and 36°C (TTM36) in patients with ROSC after OHCA (NEJM 2013). We assessed the interaction of the two levels of TTM and age, time to ROSC, bystander CPR, lactate at admission and sex on mortality in the subgroup of 178 patients resuscitated from OHCA with NSR.
RESULTS: Compared to patients presenting with shockable rhythm, patients with an initial NSR had longer time to ROSC, less frequently had bystander CPR, had higher lactate levels on admission,and a higher overall mortality rate (p<0.001 for all 4 factors). No differential effect of TTM at the two levels was found on mortality or on the following pre-specified early risk factors of OHCA with NSR: age (risk ratio for TTM36 (RR) 1.01; confidence interval (CI) 0.98-1.05), time to ROSC (RR 0.99; CI 0.98-1.00), bystander CPR (RR 0.85; CI 0.43-1.67), lactate (RR 0.98; CI 0.91-1.04) and sex (RR 1.45; CI 0.66-3.20).
CONCLUSION: Overall mortality rate and the prognostic information of early risk factors of mortality in patients resuscitated from NSR appear to be unaltered by level of TTM. The risk associated with these factors seems to have less importance than in shockable primary rhythm in NSR.
Author Disclosures: M. Frydland: None. C. Hassager: None. N. Nielsen: None. M. Wanscher: None. T. Cronberg: None. D. Erlinge: Speakers Bureau; Modest; ZOLL, Philips. H. Friberg: None. J. Horn: None. J. Hovdenes: None. M. Kuiper: None. Y. Gasche: None. T. Pellis: None. P. Stammet: None. J. Wetterslev: None. M.P. Wise: None. A. åneman: None. J. Kjaergaard: None.
- © 2014 by American Heart Association, Inc.