Abstract 16915: Later Onset of Pyrexia Associated With Better Outcomes in Post-arrest Patients Treated With Targeted Temperature Management
Introduction: Post-arrest pyrexia has been associated with worse outcomes in recent studies. While targeted temperature management (TTM) serves as prophylaxis against pyrexia during active temperature management, it is unknown how the timing of post-TTM pyrexia relates to outcomes. In patients who had a post-arrest temperature ≥38°C, we sought to evaluate the association between timing of pyrexic temperatures post-arrest and after the initiation of TTM and neurologic outcomes at hospital discharge.
Hypothesis: We hypothesized that later timing of pyrexia would be associated with worse outcomes.
Methods: We identified cardiac arrest patients who returned to normothermia following TTM with serial temperatures recorded during 144 hours post-arrest from a US multicenter registry. Our dependent variable was neurologic outcome (Cerebral Performance Category (CPC) score dichotomized into “good” (1-2) and “poor” (3-5)); secondary outcome was survival to hospital discharge. Time to pyrexia onset was defined as the first time there was a recorded temperature ≥38°C after the patient had completed TTM maintenance and returned to a temperature ≥36.5°C.
Results: Of 502 TTM-treated patients at 14 hospitals between 2005-2015 who had serial temperatures recorded, 466 patients had information on the time between collapse and post-normothermia temperatures; 195 (42%) had a pyrexic temperature. Of the initial 502 patients, 434 patients had data on the time between induction of TTM and post-normothermia temperatures; 201 (46%) had a pyrexic temperature. Mean age in the whole cohort was 59±16 years, 59% were male, and 39% had an initial shockable rhythm. 44% survived to hospital discharge; 34% had a CPC 1-2 at discharge. In adjusted analyses, delayed onset of fever was associated with improved neurologic (OR from induction: 1.1, 95% CI 1.0-1.2, p<0.05; OR from collapse: 1.1, 95% CI: 1.0-1.2, p=0.04) and survival outcomes (OR from induction: 1.1, 95% CI: 1.0-1.2, p=0.02; OR from collapse: 1.1, 95% CI: 1.0-1.1, p=0.05).
Conclusions: Later onset of pyrexia following TTM is associated with better survival and neurologic outcomes. Whether active maintenance of normothermia would prevent early pyrexia and improve outcomes requires further investigation.
Author Disclosures: A.V. Grossestreuer: Research Grant; Significant; American Heart Association. B.S. Abella: Research Grant; Significant; NHLBI, PCORI, Medtronic, CR Bard, American Heart Association. Honoraria; Modest; CR Bard, Physio-Control. Consultant/Advisory Board; Modest; Ikaria Inc, CardioReady. M.W. Donnino: Research Grant; Significant; NIH, American Heart Association. D.J. Wiebe: None. D.F. Gaieski: None.
- © 2016 by American Heart Association, Inc.