Abstract 17084: Timing of Onset of Pyrexia and Cardiac Arrest Outcomes by Duration of Targeted Temperature Management
Introduction: Post-arrest pyrexia (≥38°C) has been associated with poor outcomes in recent clinical studies. Optimal duration and degree of targeted temperature management (TTM) remain unclear. It is unknown to what extent the association of timing of post-TTM pyrexia with clinical outcomes is affected by duration of TTM maintenance.
Hypothesis: We hypothesized that duration of TTM would modify the relationship between timing of onset of pyrexia and outcomes.
Methods: We included post-arrest data from a US multicenter registry. We tested for effect modification in univariate analysis using Mantel-Hanszel tests and in multivariate logistic regression using interaction terms. Our primary outcome was neurologic status (Cerebral Performance Category (CPC) score dichotomized into “good” (1-2) and “poor” (3-5)); secondary outcome was survival to hospital discharge. We reported the distribution of patient and arrest factors by duration of TTM to explore whether these affected the relationship. We repeated this with two different calculations regarding timing: 1) time from induction of TTM to pyrexia onset; 2) time from normothermia to pyrexia onset.
Results: Of 502 TTM-treated patients at 14 hospitals between 2005-2015 with serial temperatures in the time frame of interest, 466 patients had data on time between arrest and onset of pyrexia; 195 (42%) had a pyrexic temperature. Mean age was 59±16 years, 58% male, 41% had initial VF/VT, 47% survived and 36% had CPC 1-2 at hospital discharge. In unadjusted and adjusted analyses, the relationship between time to onset of pyrexia and outcomes were significantly modified by duration of TTM; early fever was beneficial for patients with long TTM and late fever beneficial for those with short (Figure 1). Patients differed significantly by group of TTM duration in terms of arrest duration and time to target temperature.
Conclusions: Duration of TTM may modify the relationship between timing of post-arrest pyrexia and outcomes.
Author Disclosures: A.V. Grossestreuer: Research Grant; Significant; American Heart Association. B.S. Abella: Research Grant; Significant; NHLBI, American Heart Association, PCORI, CR Bard, Medtronic. Honoraria; Modest; CR Bard, Physio-Control. Consultant/Advisory Board; Modest; Ikaria Inc, CardioReady. D.J. Wiebe: None. M.W. Donnino: Research Grant; Significant; NIH, American Heart Association. D.F. Gaieski: None.
- © 2016 by American Heart Association, Inc.