Targeted Temperature Management After In-Hospital Cardiac Arrest: An Ancillary Analysis of Targeted Temperature Management for Cardiac Arrest With Nonshockable Rhythm Trial Data.

Autor:	Blanc A; Médecine Intensive Réanimation, University Hospital Center, Nantes, France., Colin G; Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France., Cariou A; Paris Cardiovascular Research Center, INSERM U970, Paris, France; Medical Intensive Care Unit, Cochin University Hospital Center, Paris, France; AfterROSC Network, Cochin University Hospital Center, Paris, France., Merdji H; Faculté de Médecine Université de Strasbourg (UNISTRA) and the Service de Médecine Intensive Réanimation (H. Merdji), Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, Strasbourg, France; UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France., Grillet G; Medical Intensive Care Unit, South Brittany General Hospital Center, Lorient, France., Girardie P; Médecine Intensive Réanimation, CHU Lille, and the Université de Lille, Faculté de Médicine, Lille, France., Coupez E; Medical Intensive Care Unit, University Hospital Center, Clermond-Ferrand, France., Dequin PF; Medical Intensive Care Unit, University Hospital Center, Tours, France; Inserm UMR 1100-Centre d'Étude des Pathologies Respiratoires, Tours University, Tours, France., Boulain T; Medical Intensive Care Unit, Regional Hospital Center, Orleans, France., Frat JP; Medical Intensive Care Unit, University Hospital Center, Poitiers, France; INSERM, CIC-1402, Équipe ALIVE, Poitiers, France; Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France., Asfar P; Medical Intensive Care Unit, University Hospital Center, Angers, France., Pichon N; AfterROSC Network, Cochin University Hospital Center, Paris, France; Service de Réanimation Polyvalente, University Hospital Center, Limoges, France; CIC 1435, University Hospital Center, Limoges, France., Landais M; Medical-Surgical Intensive Care Unit, General Hospital Center, Le Mans, France., Plantefeve G; Medical-Surgical Intensive Care Unit, General Hospital Center, Argenteuil, France., Quenot JP; Medical Intensive Care Unit, University Hospital Center, Dijon, France., Chakarian JC; Medical-Surgical Intensive Care Unit, General Hospital Center, Roanne, France., Sirodot M; Medical-Surgical Intensive Care Unit, General Hospital Center, Annecy, France., Legriel S; AfterROSC Network, Cochin University Hospital Center, Paris, France; Medical-Surgical Intensive Care Unit, Versailles Hospital, Versailles, France., Massart N; Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Brieuc, France., Thevenin D; Medical-Surgical Intensive Care Unit, General Hospital Center, Lens, France., Desachy A; Medical-Surgical Intensive Care Unit, General Hospital Center, Angouleme, France., Delahaye A; Medical-Surgical Intensive Care Unit, General Hospital Center, Rodez, France., Botoc V; Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Malo, France., Vimeux S; Medical-Surgical Intensive Care Unit, General Hospital Center, Montauban, France., Martino F; Medical Intensive Care Unit, University Hospital Center, Pointe-à-Pitre, France., Reignier J; Médecine Intensive Réanimation, University Hospital Center, Nantes, France., Taccone FS; Erasmus University Hospital, Free University of Brussels, Brussels, Belgium., Lascarrou JB; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; Paris Cardiovascular Research Center, INSERM U970, Paris, France; AfterROSC Network, Cochin University Hospital Center, Paris, France. Electronic address: jeanbaptiste.lascarrou@chu-nantes.fr.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2022 Aug; Vol. 162 (2), pp. 356-366. Date of Electronic Publication: 2022 Mar 19.
DOI:	10.1016/j.chest.2022.02.056
Abstrakt:	Background: Targeted temperature management (TTM) currently is the only treatment with demonstrated efficacy in attenuating the harmful effects on the brain of ischemia-reperfusion injury after cardiac arrest. However, whether TTM is beneficial in the subset of patients with in-hospital cardiac arrest (IHCA) remains unclear. Research Question: Is TTM at 33 °C associated with better neurological outcomes after IHCA in a nonshockable rhythm compared with targeted normothermia (TN; 37 °C)? Study Design and Methods: We performed a post hoc analysis of data from the published Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm randomized controlled trial in 584 patients. We included the 159 patients with IHCA; 73 were randomized to 33 °C treatment and 86 were randomized to 37 °C treatment. The primary outcome was survival with a good neurologic outcome (cerebral performance category [CPC] score of 1 or 2) on day 90. Mixed multivariate adjusted logistic regression analysis was performed to determine whether survival with CPC score of 1 or 2 on day 90 was associated with type of temperature management after adjustment on baseline characteristics not balanced by randomization. Results: Compared with TN for 48 h, hypothermia at 33 °C for 24 h was associated with a higher percentage of patients who were alive with good neurologic outcomes on day 90 (16.4% vs 5.8%; P = .03). Day 90 mortality was not significantly different between the two groups (68.5% vs 76.7%; P = .24). By mixed multivariate analysis adjusted by Cardiac Arrest Hospital Prognosis score and circulatory shock status, hypothermia was associated significantly with good day 90 neurologic outcomes (OR, 2.40 [95% CI, 1.17-13.03]; P = .03). Interpretation: Hypothermia at 33 °C was associated with better day 90 neurologic outcomes after IHCA in a nonshockable rhythm compared with TN. However, the limited sample size resulted in wide CIs. Further studies of patients after cardiac arrest resulting from any cause, including IHCA, are needed. (Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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