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Open Access 01-04-2011 | Research

Relationship between time to target temperature and outcome in patients treated with therapeutic hypothermia after cardiac arrest

Authors: Moritz Haugk, Christoph Testori, Fritz Sterz, Maximilian Uranitsch, Michael Holzer, Wilhelm Behringer, Harald Herkner, the Time to Target Temperature Study Group

Published in: Critical Care | Issue 2/2011

Abstract

Introduction

Our purpose was to study whether the time to target temperature correlates with neurologic outcome in patients after cardiac arrest with restoration of spontaneous circulation treated with therapeutic mild hypothermia in an academic emergency department.

Methods

Temperature data between April 1995 and June 2008 were collected from 588 patients and analyzed in a retrospective cohort study by observers blinded to outcome. The time needed to achieve an esophageal temperature of less than 34°C was recorded. Survival and neurological outcomes were determined within six months after cardiac arrest.

Results

The median time from restoration of spontaneous circulation to reaching a temperature of less than 34°C was 209 minutes (interquartile range [IQR]: 130-302) in patients with favorable neurological outcomes compared to 158 min (IQR: 101-230) (P < 0.01) in patients with unfavorable neurological outcomes. The adjusted odds ratio for a favorable neurological outcome with a longer time to target temperature was 1.86 (95% CI 1.03 to 3.38, P = 0.04).

Conclusions

In comatose cardiac arrest patients treated with therapeutic hypothermia after return of spontaneous circulation, a faster decline in body temperature to the 34°C target appears to predict an unfavorable neurologic outcome.

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Holzer M, Cerchiari E, Martens P, Roine R, Sterz F, Eisenburger P, Havel C, Kofler J, Oschatz E, Rohrbach K, Scheinecker W, Schörkhuber W, Behringer W, Zeiner A, Valentin A, De Meyer M, Takunen O, Tiainen M, Hachimi-Idrissi S, Huyegens L, Fischer M, Walger P, Bartsch A, Födisch M, Bonnizoli M, Pagni E, Kaff A, Schneider B, Müllner M: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002, 346: 549-556. 10.1056/NEJMoa012689CrossRef

Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002, 346: 557-563. 10.1056/NEJMoa003289CrossRefPubMed

Wolff B, Machill K, Schumacher D, Schulzki I, Werner D: Early achievement of mild therapeutic hypothermia and the neurologic outcome after cardiac arrest. Int J Cardiol 2009, 133: 223-228. 10.1016/j.ijcard.2007.12.039CrossRefPubMed

Kim F, Olsufka M, Longstreth WT Jr, Maynard C, Carlbom D, Deem S, Kudenchuk P, Copass MK, Cobb LA: Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation 2007, 115: 3064-3070. 10.1161/CIRCULATIONAHA.106.655480CrossRefPubMed

Arrich J: Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 2007, 35: 1041-1047. 10.1097/01.CCM.0000259383.48324.35CrossRefPubMed

Oksanen T, Pettila V, Hynynen M, Varpula T: Therapeutic hypothermia after cardiac arrest: implementation and outcome in Finnish intensive care units. Acta Anaesthesiol Scand 2007, 51: 866-871. 10.1111/j.1399-6576.2007.01365.xCrossRefPubMed

Nielsen N, Hovdenes J, Nilsson F, Rubertsson S, Stammet P, Sunde K, Valsson F, Wanscher M, Friberg H, Hypothermia Network: Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2009, 53: 926-934. 10.1111/j.1399-6576.2009.02021.xCrossRefPubMed

Holzer M, Mullner M, Sterz F, Robak O, Kliegel A, Losert H, Sodeck G, Uray T, Zeiner A, Laggner AN: Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach. Stroke 2006, 37: 1792-1797. 10.1161/01.STR.0000227265.52763.16CrossRefPubMed

Uray T, Haugk M, Sterz F, Arrich J, Richling N, Janata A, Holzer M, Behringer W: Surface cooling for rapid induction of mild hypothermia after cardiac arrest: design determines efficacy. Acad Emerg Med 2010, 17: 360-367. 10.1111/j.1553-2712.2010.00700.xCrossRefPubMed

10.

Kliegel A, Janata A, Wandaller C, Uray T, Spiel A, Losert H, Kliegel M, Holzer M, Haugk M, Sterz F, Laggner AN: Cold infusions alone are effective for induction of therapeutic hypothermia but do not keep patients cool after cardiac arrest. Resuscitation 2007, 73: 46-53. 10.1016/j.resuscitation.2006.08.023CrossRefPubMed

11.

Haugk M, Sterz F, Grassberger M, Uray T, Kliegel A, Janata A, Richling N, Herkner H, Laggner AN: Feasibility and efficacy of a new non-invasive surface cooling device in post-resuscitation intensive care medicine. Resuscitation 2007, 75: 76-81. 10.1016/j.resuscitation.2007.03.001CrossRefPubMed

12.

Wandaller C, Holzer M, Sterz F, Wandaller J, Arrich J, Uray T, Laggner AN, Herkner H: Head and neck cooling after cardiac arrest results in lower jugular bulb than esophageal temperature. Am J Emerg Med 2009, 27: 460-465. 10.1016/j.ajem.2008.03.036CrossRefPubMed

13.

Zeiner A, Holzer M, Sterz F, Behringer W, Schorkhuber W, Mullner M, Frass M, Siostrzonek P, Ratheiser K, Kaff A, Laggner AN: Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group. Stroke 2000, 31: 86-94.CrossRefPubMed

14.

Holzer M: Targeted temperature management for comatose survivors of cardiac arrest. N Engl J Med 2010, 363: 1256-1264. 10.1056/NEJMct1002402CrossRefPubMed

15.

Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, Bossaert L, Delooz HH, Dick WF, Eisenberg MS, Evans TR, Holmberg S, Kerber R, Mullie A, Ornato JP, Sandoe E, Skulberg A, Tunstall-Pedoe H, Swanson R, Thies WH: Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991, 84: 960-975.CrossRefPubMed

16.

Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D'Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, et al.: Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004, 63: 233-249. 10.1016/j.resuscitation.2004.09.008CrossRefPubMed

17.

Lefrant JY, Muller L, de La Coussaye JE, Benbabaali M, Lebris C, Zeitoun N, Mari C, Saïssi G, Ripart J, Eledjam JJ: Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med 2003, 29: 414-418.PubMed

18.

Haugk M, Stratil P, Sterz F, Krizanac D, Testori C, Uray T, Losert UM, Sterz F: Temperature monitored on the cuff surface of an endotracheal tube reflects body temperature. Crit Care Med 2010, 38: 1569-1574. 10.1097/CCM.0b013e3181e47a20CrossRefPubMed

19.

Sessler DI: Thermoregulatory defense mechanisms. Crit Care Med 2009, 37: S203-S210. 10.1097/CCM.0b013e3181aa5568CrossRefPubMed

20.

Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Bottiger BW, Callaway C, Clark RS, Geocadin RG, Jauch EC, Kern KB, Laurent I, Longstreth WT Jr, Merchant RM, Morley P, Morrison LJ, Nadkarni V, Peberdy MA, Rivers EP, Rodriguez-Nunez A, Sellke FW, Spaulding C, Sunde K, Vanden Hoek T: Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation 2008, 118: 2452-2483. 10.1161/CIRCULATIONAHA.108.190652CrossRefPubMed

21.

Howes D, Ohley W, Dorian P, Klock C, Freedman R, Schock R, Krizanac D, Holzer M: Rapid induction of therapeutic hypothermia using convective-immersion surface cooling: safety, efficacy and outcomes. Resuscitation 2010, 81: 388-392. 10.1016/j.resuscitation.2009.12.025PubMedCentralCrossRefPubMed

22.

Lyon RM, Richardson SE, Hay AW, Andrews PJ, Robertson CE, Clegg GR: Esophageal temperature after out-of-hospital cardiac arrest: an observational study. Resuscitation 2010, 81: 867-871. 10.1016/j.resuscitation.2010.03.017CrossRefPubMed

23.

Majersik JJ, Silbergleit R, Meurer WJ, Brown DL, Lisabeth LD, Morgenstern LB: Public health impact of full implementation of therapeutic hypothermia after cardiac arrest. Resuscitation 2008, 77: 189-194. 10.1016/j.resuscitation.2007.11.023CrossRefPubMed

24.

Coimbra C, Wieloch T: Moderate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia. Acta Neuropathol 1994, 87: 325-331. 10.1007/BF00313599CrossRefPubMed

25.

Colbourne F, Corbett D, Zhao ZH, Yang J, Buchan AM: Prolonged but delayed postischemic hypothermia: a long-term outcome study in the rat middle cerebral artery occlusion model. J Cereb Blood Flow Metab 2000, 20: 1702-1708. 10.1097/00004647-200012000-00009CrossRefPubMed

26.

Kuboyama K, Safar P, Radovsky A, Tisherman SA, Stezoski SW, Alexander H: Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study [see comments]. Crit Care Med 1993, 21: 1348-1358. 10.1097/00003246-199309000-00019CrossRefPubMed

Title: Relationship between time to target temperature and outcome in patients treated with therapeutic hypothermia after cardiac arrest
Authors: Moritz Haugk
Christoph Testori
Fritz Sterz
Maximilian Uranitsch
Michael Holzer
Wilhelm Behringer
Harald Herkner
the Time to Target Temperature Study Group
Publication date: 01-04-2011
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2011
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc10116

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Relationship between time to target temperature and outcome in patients treated with therapeutic hypothermia after cardiac arrest

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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