Abstract 17799: Have We Abandoned Therapeutic Hypothermia Prematurely?
Introduction: Following the recent Targeted Temperature Management (TTM) Trial, many worldwide cardiac arrest centers have adjusted target temperatures from 330C to 360C. The aim of this study was to examine quality of post-arrest care in an expert cardiac center following the adoption of a TTM protocol.
Methods: We conducted an audit of consecutive ventricular fibrillation out-of-hospital cardiac arrest (VF-OHCA) patients of presumed cardiac etiology, admitted to a quaternary referral cardiac hospital in Australia.
Results: Over the two-year period there were 70 VF-OHCAs admitted (28 before TTM change and 42 after). Patient demographics, arrest features including witnessed arrest, bystander CPR and arrest duration were all similar, between the two periods. Post-arrest care including cardiology consults (93% vs 100%, p=0.15), coronary angiography (79% vs. 76%, p=0.82) and documented orders for TTM were all equivalent. Compliance, however, with temperature management was significantly worse in the 360C period; the average time at target temperature was significantly lower in this time (22hrs vs. 8hrs, p<0.001). 50% of patients recorded temperatures >37.1o in the first 24-hours in the 360C, compared to 0% of patients during the 330C period. Survival to hospital discharge (75% vs 69%, p = 0.59) and rates of discharge to home among (59% vs 45%, p = 0.32) were similar between 330C and 360C periods. After adjustment for arrest duration, an abnormal temperature (>37.10C) in the first 24hours following hospital admission was associated with hypoxic brain injury (AOR=4.55, 95%CI: 1.08-19.09, p=0.039).
Conclusion: Revision of the TTM protocol in an expert cardiac centre was associated with significant non-compliance with target temperatures, leading to increased febrile patients in the post arrest period and possible poorer outcomes.
Author Disclosures: J. Bray: None. J. Bloom: None. D. Stub: None. L. Segan: None. B. Mitra: None. K. Smith: None. J. Finn: None. S. Bernard: None.
- © 2015 by American Heart Association, Inc.