Effect of target temperature management at 32–34 °C in cardiac arrest patients considering assessment by regional cerebral oxygen saturation: A multicenter retrospective cohort study

• Published in: Resuscitation Vol. 126; pp. 185 - 190
• Main Authors: Nakatani, Yuka, Nakayama, Takeo, Nishiyama, Kei, Takahashi, Yoshimitsu
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2018
• Subjects: Aged; Aged, 80 and over; Cerebrovascular Circulation; Coma - mortality; Coma - therapy; Female; Humans; Hypothermia; Hypothermia, Induced - methods; Hypothermia, Induced - mortality; Induced; Japan - epidemiology; Logistic Models; Male; Middle Aged; Near-Infrared; Out-of-Hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Oxygen Consumption; Propensity Score; Registries; Resuscitation; Retrospective Studies; Spectroscopy; Japan; Spectroscopy; Retrospective studies; Propensity score; Out-of-Hospital cardiac arrest; Near-Infrared; Resuscitation; Hypothermia; Induced
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2018.02.007

Target temperature management (TTM) is used in comatose post-cardiac arrest patients, but the recommended temperature range is wide. This study aimed to assess the effectiveness of TTM at 32–34 °C while considering the degree of cerebral injury and cerebral circulation, as assessed by regional cerebral oxygen saturation (rSO2). This is a secondary analysis of prospectively collected registry data from comatose patients who were transferred to 15 hospitals in Japan after out-of-hospital cardiac arrest (OHCA) from 2011 to 2013. The primary outcome was all-cause mortality at 90 days after OHCA, and the secondary outcome was favorable neurological outcomes as evaluated according to the Cerebral Performance Category. We monitored rSO2 noninvasively with near-infrared spectroscopy, which could assess cerebral perfusion and the balance of oxygen delivery and uptake. We stratified 431 study patients into three groups according to rSO2 on hospital arrival: rSO2 ≤40% (n = 296), rSO2 41–60% (n = 67), and rSO2 ≥61% (n = 68). Propensity score analysis revealed that TTM at 32–34 °C decreased all-cause mortality in patients with rSO2 41–60% (average treatment effect on treated [ATT] by propensity score matching [PSM] −0.51, 95%CI −0.70 to −0.33; ATT by inverse probability of treatment weighting [IPW] −0.52, 95%CI −0.71 to −0.34), and increased favorable neurological outcomes in patients with rSO2 41–60% (ATT by PSM 0.50, 95%CI 0.32–0.68; ATT by IPW 0.52, 95%CI 0.35–0.69). TTM at 32–34 °C effectively decreased all-cause mortality in comatose OHCA patients with rSO2 41–60% on hospital arrival in Japan.