Temporal Trends in the Use of Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest

Autor: Gary K. Grunwald, Michael R. Mooney, Timothy D. Henry, Bryan McNally, Kimberly Vellano, Steven M. Bradley, Wenhui Liu, Saket Girotra, Mehul Adhaduk, M. Nicholas Burke, Emmanouil S. Brilakis, Michael W. Donnino
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Cardiology
030204 cardiovascular system & hematology
Targeted temperature management
Ventricular tachycardia
03 medical and health sciences
0302 clinical medicine
Patient Admission
Hypothermia
Induced
Internal medicine
medicine
Odds Ratio
Humans
030212 general & internal medicine
Hospital Mortality
Registries
Asystole
Practice Patterns
Physicians'
Pulse
Original Investigation
Aged
Randomized Controlled Trials as Topic
Retrospective Studies
business.industry
Research
Retrospective cohort study
General Medicine
Odds ratio
Hypothermia
Middle Aged
medicine.disease
United States
Heart Arrest
Online Only
Logistic Models
Pulseless electrical activity
Ventricular fibrillation
Practice Guidelines as Topic
Ventricular Fibrillation
Tachycardia
Ventricular
Female
Guideline Adherence
medicine.symptom
business
Out-of-Hospital Cardiac Arrest
Zdroj: JAMA Network Open
ISSN: 2574-3805
Popis: Importance Despite evidence that therapeutic hypothermia improves patient outcomes for out-of-hospital cardiac arrest, use of this therapy remains low. Objective To determine whether the use of therapeutic hypothermia and patient outcomes have changed after publication of the Targeted Temperature Management trial on December 5, 2013, which supported more lenient temperature management for out-of-hospital cardiac arrest. Design, Setting, and Participants A retrospective cohort was conducted between January 1, 2013, and December 31, 2016, of 45 935 US patients in the Cardiac Arrest Registry to Enhance Survival who experienced out-of-hospital cardiac arrest and survived to hospital admission. Exposures Calendar time by quarter year. Main Outcomes and Measures Use of therapeutic hypothermia and patient survival to hospital discharge. Results Among 45 935 patients (17 515 women and 28 420 men; mean [SD] age, 59.3 [18.3] years) who experienced out-of-hospital cardiac arrest and survived to admission at 649 US hospitals, overall use of therapeutic hypothermia during the study period was 46.4%. In unadjusted analyses, the use of therapeutic hypothermia dropped from 52.5% in the last quarter of 2013 to 46.0% in the first quarter of 2014 after the December 2013 publication of the Targeted Temperature Management trial. Use of therapeutic hypothermia remained at or below 46.5% through 2016. In segmented hierarchical logistic regression analysis, the risk-adjusted odds of use of therapeutic hypothermia was 18% lower in the first quarter of 2014 compared with the last quarter of 2013 (odds ratio, 0.82; 95% CI, 0.71-0.94; P = .006). Similar point-estimate changes over time were observed in analyses stratified by presenting rhythm of ventricular tachycardia or ventricular fibrillation (odds ratio, 0.89; 95% CI, 0.71-1.13, P = .35) and pulseless electrical activity or asystole (odds ratio, 0.75; 95% CI, 0.63-0.89; P = .001). Overall risk-adjusted patient survival was 36.9% in 2013, 37.5% in 2014, 34.8% in 2015, and 34.3% in 2016 (P
This cohort study examines whether the use of therapeutic hypothermia and patient survival have changed after publication of the Targeted Temperature Management trial, which supported more lenient temperature management for out-of-hospital cardiac arrest.
Key Points Question Did the use of therapeutic hypothermia for out-of-hospital cardiac arrest change after publication of a trial that supported more lenient temperature goals? Findings In a cohort study of 45 935 US patients who experienced out-of-hospital cardiac arrest and survived to hospital admission, the risk-adjusted odds of the use of therapeutic hypothermia decreased 18% in the first quarter of 2014 after publication of the Targeted Temperature Management trial, compared with the last quarter of 2013. Risk-adjusted patient survival also decreased during the study period, but was not mediated by trends in hypothermia use. Meaning In a US registry of patients who experienced out-of-hospital cardiac arrest, the use of guideline-recommended active cooling decreased after publication of the Targeted Temperature Management trial.
Databáze: OpenAIRE
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