Quality of targeted temperature management and outcome of out-of-hospital cardiac arrest patients: A post hoc analysis of the TTH48 study

• Published in: Resuscitation Vol. 165; pp. 85 - 92
• Main Authors: De Fazio, Chiara, Skrifvars, Markus B., Søreide, Eldar, Grejs, Anders M., Di Bernardini, Eugenio, Jeppesen, Anni Nørgaard, Storm, Christian, Kjaergaard, Jesper, Laitio, Timo, Rasmussen, Bodil Sten, Tianen, Marjaana, Kirkegaard, Hans, Taccone, Fabio Silvio
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.08.2021
• Subjects: Cardiac arrest; Outcome; Quality; Targeted temperature management; Quality; Outcome; Cardiac arrest; Targeted temperature management
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2021.06.007

No data are available on the quality of targeted temperature management (TTM) provided to out-of-hospital cardiac arrest (OHCA) patients and its association with outcome. Post hoc analysis of the TTH48 study (NCT01689077), which compared the effects of prolonged TTM at 33 °C for 48 h to standard 24-h TTM on neurologic outcome. Admission temperature, speed of cooling, rewarming rates, precision (i.e. temperature variability), overcooling and overshooting as post-cooling fever (i.e. >38.0 °C) were collected. A specific score, ranging from 1 to 9, was computed to define the “quality of TTM”. On a total of 352 patients, most had a moderate quality of TTM (n = 217; 62% — score 4–6), while 80 (23%) patients had a low quality of TTM (score 1–3) and only 52 (16%) a high quality of TTM (score 7–9). The proportion of patients with unfavorable neurological outcome (UO; Cerebral Performance Category of 3–5 at 6 months) was similar between the different quality of TTM groups (p = 0.90). Although a shorter time from arrest to target temperature and a lower proportion of time outside the target ranges in the TTM 48-h than in the TTM 24-h group, quality of TTM was similar between groups. Also, the proportion of patients with UO was similar between the different quality of TTM groups when TTM 48-h and TTM 24-h were compared. In this study, high quality of TTM was provided to a small proportion of patients. However, quality of TTM was not associated with patients’ outcome.