Abstract 19415: Temperature Management After Aortic Arch Surgery With Deep Hypothermic Circulatory Arrest Affects Survival and Neurologic Outcome
Introduction: Therapeutic hypothermia is recommended by international guidelines after cardio-circulatory arrest. However the effect of different temperature during first 24 h after deep hypothermic circulatory arrest (DHCA) for aortic arch surgery on survival and neurologic outcome are undefined.
Hypothesis: We hypothesize that target temperature management after aortic arch surgery could affect survival and neurologic outcome.
Methods: In the period 2010-2014, a total of 210 consecutive patients undergoing aortic arch surgery with DHCA were included. They were retrospectively divided in three groups by median peak nasopharyngeal temperature within 24 h after rewarming: hypothermia (<36°C; n = 65), normothermia (36-37°C; n = 110), hyperpyrexia (>37°C; n = 35). Multivariate stepwise logistic and linear regressions were performed to determine whether different temperature independently predicted 30-day mortality, stroke incidence and neurologic outcome assessed by Cerebral Performance Category (CPC) at hospital discharge.
Results: Compared with hypothermia and normothermia, hyperpyrexia was associated independently with a higher risk of 30-day mortality (35.7% vs 6.5%; odds ratio [OR], 9.4; 95% confidence interval [CI], 1.1-81.6; P= .005), stroke incidence (64.3% vs 13.3%; OR 9.3; 95% CI, 2.9-92.3; P= .002) and poor neurologic outcome (CPC 3-5) (85.7% vs 36.9%; OR 4.5; 95% CI, 0.9- 87.6; P= .01). No significant differences were demonstrated between hypothermia and normothermia.
Conclusions: Post-operative hypothermia is not associated with better outcome after aortic arch surgery with DHCA. However post-operative fever (>37°C) is associated with high stroke incidence, poor neurologic outcome and increased 30-day mortality. Target temperature management in the first 24 h after surgery should be evaluated in prospective randomized trials.
Author Disclosures: A. Rungatscher: None. G. Luciani: None. D. Linardi: None. E. Milani: None. L. Gottin: None. B. Walpoth: None. G. Faggian: None.
- © 2015 by American Heart Association, Inc.