Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Expert Opinion | Research

Temporal trends in the use of targeted temperature management after cardiac arrest and association with outcome: insights from the Paris Sudden Death Expertise Centre

Authors: Jean-Baptiste Lascarrou, Florence Dumas, Wulfran Bougouin, Richard Chocron, Frankie Beganton, Stephane Legriel, Nadia Aissaoui, Nicolas Deye, Lionel Lamhaut, Daniel Jost, Antoine Vieillard-Baron, Eloi Marijon, Xavier Jouven, Alain Cariou, on behalf of the SDEC

Published in: Critical Care | Issue 1/2019

Login to get access

Abstract

Purpose

Recent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome.

Methods

We used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale.

Results

Between May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome.

Conclusions

We report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in “no flow” duration.
Appendix
Available only for authorised users
Literature
1.
Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, Rajan S, Lippert F, Folke F, Gislason G, et al. Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest. New England J Med. 2017;376(18):1737–47.PubMedCrossRef
2.
Dumas F, Grimaldi D, Zuber B, Fichet J, Charpentier J, Pene F, Vivien B, Varenne O, Carli P, Jouven X, et al. Is hypothermia after cardiac arrest effective in both shockable and nonshockable patients? Insights from a large registry. Circulation. 2011;123(8):877–86.PubMedCrossRef
3.
Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369(23):2197–206.PubMedCrossRef
4.
Nielsen N, Friberg H, Gluud C, Herlitz J, Wetterslev J. Hypothermia after cardiac arrest should be further evaluated--a systematic review of randomised trials with meta-analysis and trial sequential analysis. Int J Cardiol. 2011;151(3):333–41.PubMedCrossRef
5.
Salter R, Bailey M, Bellomo R, Eastwood G, Goodwin A, Nielsen N, Pilcher D, Nichol A, Saxena M, Shehabi Y, et al. Changes in temperature management of cardiac arrest patients following publication of the target temperature management trial. Crit Care Med. 2018;46(11):1722–30.PubMedCrossRef
6.
Deye N, Vincent F, Michel P, Ehrmann S, Silva D, Piagnerelli M, Kimmoun A, Hamzaoui O, Lacherade J-C, Jonghe B, et al. Changes in cardiac arrest patients’ temperature management after the 2013 “TTM” trial: results from an international survey. Ann Intensive Care. 2016;6(1):1–9.CrossRef
7.
Bray JE, Stub D, Bloom JE, Segan L, Mitra B, Smith K, Finn J, Bernard S. Changing target temperature from 33 degrees C to 36 degrees C in the ICU management of out-of-hospital cardiac arrest: a before and after study. Resuscitation. 2017;113:39–43.PubMedCrossRef
8.
Bradley SM, Liu W, McNally B, et al. Temporal trends in the use of therapeutic hypothermia for out-of-hospital cardiac arrest. JAMA Netw Open. 2018;1(7):e184511.PubMedPubMedCentralCrossRef
9.
Khera R, Humbert A, Leroux B, Nichol G, Kudenchuk P, Scales D, Baker A, Austin M, Newgard CD, Radecki R, et al. Hospital variation in the utilization and implementation of targeted temperature management in out-of-hospital cardiac arrest. Circulation. 2018;11(11):e004829.PubMed
10.
11.
Bougouin W, Lamhaut L, Marijon E, Jost D, Dumas F, Deye N, Beganton F, Empana JP, Chazelle E, Cariou A, et al. Characteristics and prognosis of sudden cardiac death in Greater Paris: population-based approach from the Paris Sudden Death Expertise Center (Paris-SDEC). Intensive Care Med. 2014;40(6):846–54.PubMedCrossRef
12.
Maupain C, Bougouin W, Lamhaut L, Deye N, Diehl JL, Geri G, Perier MC, Beganton F, Marijon E, Jouven X, et al. The CAHP (Cardiac Arrest Hospital Prognosis) score: a tool for risk stratification after out-of-hospital cardiac arrest. Eur Heart J. 2016;37(42):3222–8.PubMedCrossRef
13.
Bougouin W, Dumas F, Karam N, Maupain C, Marijon E, Lamhaut L, Jost D, Geri G, Beganton F, Varenne O, et al. Should we perform an immediate coronary angiogram in all patients after cardiac arrest?: insights from a large French registry. JACC Cardiovasc Interv. 2018;11(3):249–56.PubMedCrossRef
14.
Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation. 2015;132(13):1286–1300.
15.
Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet. 1975;305(7905):480–4.CrossRef
16.
Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202–22.PubMedCrossRef
17.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.PubMedCrossRef
18.
Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299–309.PubMedCrossRef
19.
Orban JC, Cattet F, Lefrant JY, Leone M, Jaber S, Constantin JM, Allaouchiche B, Ichai C. The practice of therapeutic hypothermia after cardiac arrest in France: a national survey. PLoS One. 2012;7(9):e45284.PubMedPubMedCentralCrossRef
20.
Casamento A, Minson A, Radford S, Martensson J, Ridgeon E, Young P, Bellomo R. A comparison of therapeutic hypothermia and strict therapeutic normothermia after cardiac arrest. Resuscitation. 2016;106:83–8.PubMedCrossRef
21.
Arvidsson L, Lindgren S, Martinell L, Lundin S, Rylander C. Target temperature 34 vs. 36 degrees C after out-of-hospital cardiac arrest - a retrospective observational study. Acta anaesthesiologica Scandinavica. 2017;61(9):1176–83.PubMedCrossRef
22.
Testori C, Sterz F, Holzer M, Losert H, Arrich J, Herkner H, Krizanac D, Wallmuller C, Stratil P, Schober A, et al. The beneficial effect of mild therapeutic hypothermia depends on the time of complete circulatory standstill in patients with cardiac arrest. Resuscitation. 2012;83(5):596–601.PubMedCrossRef
23.
Kagawa E, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S, Nakama Y, Dai K, Otani T, Ikenaga H, et al. Who benefits most from mild therapeutic hypothermia in coronary intervention era? A retrospective and propensity-matched study. Critical Care (London, England). 2010;14(4):R155.CrossRef
24.
Drennan IR, Lin S, Thorpe KE, Morrison LJ. The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest. Resuscitation. 2014;85(11):1623–8.PubMedCrossRef
25.
Kjaergaard J, Nielsen N, Winther-Jensen M, Wanscher M, Pellis T, Kuiper M, Hartvig Thomsen J, Wetterslev J, Cronberg T, Bro-Jeppesen J, et al. Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest. Resuscitation. 2015;96:310–6.PubMedCrossRef
26.
Group HaCAS. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549–56.CrossRef
27.
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(8):557–63.PubMedCrossRef
28.
Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Bělohlávek J, Callaway C, Cariou A, Eastwood G, Erlinge D, Hovdenes J et al: Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2). A randomized clinical trial – rationale and design. Am Heart J 2019.
29.
Deye N, Cariou A, Girardie P, Pichon N, Megarbane B, Midez P, Tonnelier JM, Boulain T, Outin H, Delahaye A, et al. Endovascular versus external targeted temperature management for out-of-hospital cardiac arrest patients: a randomized controlled study. Circulation. 2015.
30.
Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, Jans H, Hansen PA, Lang-Jensen T, Olesen JB, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. Jama. 2013;310(13):1377–84.PubMedCrossRef
31.
van Diepen S, Girotra S, Abella BS, Becker LB, Bobrow BJ, Chan PS, Fahrenbruch C, Granger CB, Jollis JG, McNally B et al: Multistate 5-year initiative to improve care for out-of-hospital cardiac arrest: primary results from the HeartRescue Project. J Am Heart Assoc. 2017;6(9).
32.
Chocron R, Bougouin W, Beganton F, Juvin P, Loeb T, Adnet F, Lecarpentier E, Lamhaut L, Jost D, Marijon E, et al. Are characteristics of hospitals associated with outcome after cardiac arrest? Insights from the Great Paris registry. Resuscitation. 2017;118:63–9.PubMedCrossRef
33.
Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong MEH, Hazinski MF, et al. COSCA (core outcome set for cardiac arrest) in adults: an advisory statement from the international liaison committee on resuscitation. Resuscitation. 2018;127:147–63.PubMedCrossRef
34.
Taccone FS, Horn J, Storm C, Cariou A, Sandroni C, Friberg H, Hoedemaekers CA, Oddo M. Death after awakening from post-anoxic coma: the “Best CPC” project. Crit Care. 2019;23(1):107.PubMedPubMedCentralCrossRef
Metadata
Title
Temporal trends in the use of targeted temperature management after cardiac arrest and association with outcome: insights from the Paris Sudden Death Expertise Centre
Authors
Jean-Baptiste Lascarrou
Florence Dumas
Wulfran Bougouin
Richard Chocron
Frankie Beganton
Stephane Legriel
Nadia Aissaoui
Nicolas Deye
Lionel Lamhaut
Daniel Jost
Antoine Vieillard-Baron
Eloi Marijon
Xavier Jouven
Alain Cariou
on behalf of the SDEC
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2677-1

Other articles of this Issue 1/2019

Critical Care 1/2019 Go to the issue

Research

Invasive and non-invasive diagnostic approaches for microbiological diagnosis of hospital-acquired pneumonia

Research

A prospective investigation of interleukin-8 levels in pediatric acute respiratory failure and acute respiratory distress syndrome

Research

Detailed measurements of oesophageal pressure during mechanical ventilation with an advanced high-resolution manometry catheter

Research

Retrospective cohort study of hospital variation in airway management during in-hospital cardiac arrest and the association with patient survival: insights from Get With The Guidelines-Resuscitation

Letter

How to understand real net ultrafiltration and its association with low blood pressure in critically ill patients with renal replacement therapy

Research

Exploring the microvascular impact of red blood cell transfusion in intensive care unit patients