Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

Josef Dankiewicz*, Hans Friberg, Jan Bělohlávek, Andrew Walden, Christian Hassager, Tobias Cronberg, David Erlinge, Yvan Gasche, Jan Hovdenes, Janneke Horn, Jesper Kjaergaard, Michael Kuiper, Thomas Pellis, Pascal Stammet, Michael Wanscher, Jørn Wetterslev, Matthew Wise, Anders Åneman, Niklas Nielsen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Introduction: The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature management at lower temperatures. Methods: We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33 °C and 36 °C for an interaction between no-flow time and intervention group, with neurological function at six months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome. Results: No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p < 0.001). There was no statistically significant interaction between no flow-time and intervention group (p = 0.11), which may imply that the non-superior effect of 33. °C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function. Conclusions: TTM at 33. °C compared to 36. °C was not associated with an increased probability of a good neurological function for patients with longer no-flow times.

Original languageEnglish
Pages (from-to)44-49
Number of pages6
JournalResuscitation
Volume99
DOIs
Publication statusPublished - 1 Feb 2016
Externally publishedYes

Keywords

  • Cardiac arrest
  • Neurological function
  • Targeted temperature management

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