• Alexiane Blanc, Gwenhael Colin, Alain Cariou, Hamid Merdji, Guillaume Grillet, Patrick Girardie, Elisabeth Coupez, DequinPierre-FrançoisPFMedical Intensive Care Unit, University Hospital Center, Tours, France; Inserm UMR 1100-Centre d'Étude des Pathologies Respiratoires, Tours University, Tours, France., Thierry Boulain, Jean-Pierre Frat, Pierre Asfar, Nicolas Pichon, Mickael Landais, Gaëtan Plantefeve, QuenotJean-PierreJPMedical Intensive Care Unit, University Hospital Center, Dijon, France., Jean-Charles Chakarian, Michel Sirodot, Stéphane Legriel, Nicolas Massart, Didier Thevenin, Arnaud Desachy, Arnaud Delahaye, Vlad Botoc, Sylvie Vimeux, Frederic Martino, Jean Reignier, F S Taccone, and J B Lascarrou.
• Médecine Intensive Réanimation, University Hospital Center, Nantes, France.
• Chest. 2022 Aug 1; 162 (2): 356-366.

BackgroundTargeted temperature management (TTM) currently is the only treatment with demonstrated efficacy in attenuating the harmful effects on the brain of ischemia-reperfusion injury after cardiac arrest. However, whether TTM is beneficial in the subset of patients with in-hospital cardiac arrest (IHCA) remains unclear.Research QuestionIs TTM at 33 °C associated with better neurological outcomes after IHCA in a nonshockable rhythm compared with targeted normothermia (TN; 37 °C)?Study Design And MethodsWe performed a post hoc analysis of data from the published Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm randomized controlled trial in 584 patients. We included the 159 patients with IHCA; 73 were randomized to 33 °C treatment and 86 were randomized to 37 °C treatment. The primary outcome was survival with a good neurologic outcome (cerebral performance category [CPC] score of 1 or 2) on day 90. Mixed multivariate adjusted logistic regression analysis was performed to determine whether survival with CPC score of 1 or 2 on day 90 was associated with type of temperature management after adjustment on baseline characteristics not balanced by randomization.ResultsCompared with TN for 48 h, hypothermia at 33 °C for 24 h was associated with a higher percentage of patients who were alive with good neurologic outcomes on day 90 (16.4% vs 5.8%; P = .03). Day 90 mortality was not significantly different between the two groups (68.5% vs 76.7%; P = .24). By mixed multivariate analysis adjusted by Cardiac Arrest Hospital Prognosis score and circulatory shock status, hypothermia was associated significantly with good day 90 neurologic outcomes (OR, 2.40 [95% CI, 1.17-13.03]; P = .03).InterpretationHypothermia at 33 °C was associated with better day 90 neurologic outcomes after IHCA in a nonshockable rhythm compared with TN. However, the limited sample size resulted in wide CIs. Further studies of patients after cardiac arrest resulting from any cause, including IHCA, are needed.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

14 keywords...

hide…