Relationship Between Time to Target Temperature and Outcome in Patients Treated with Therapeutic Hypothermia After Cardiac Arrest

Moritz Haugk; Christoph Testori; Fritz Sterz; Maximilian Uranitsch; Michael Holzer; Wilhelm Behringer; Harald Herkner

Disclosures

Crit Care. 2011;15(2):R101 

In This Article

Abstract and Introduction

Abstract

Introduction: Our purpose was to study whether the time to target temperature correlates with neurologic outcome in patients after cardiac arrest with restoration of spontaneous circulation treated with therapeutic mild hypothermia in an academic emergency department.
Methods: Temperature data between April 1995 and June 2008 were collected from 588 patients and analyzed in a retrospective cohort study by observers blinded to outcome. The time needed to achieve an esophageal temperature of less than 34°C was recorded. Survival and neurological outcomes were determined within six months after cardiac arrest.
Results: The median time from restoration of spontaneous circulation to reaching a temperature of less than 34°C was 209 minutes (interquartile range [IQR]: 130–302) in patients with favorable neurological outcomes compared to 158 min (IQR: 101–230) (P < 0.01) in patients with unfavorable neurological outcomes. The adjusted odds ratio for a favorable neurological outcome with a longer time to target temperature was 1.86 (95% CI 1.03 to 3.38, P = 0.04).
Conclusions: In comatose cardiac arrest patients treated with therapeutic hypothermia after return of spontaneous circulation, a faster decline in body temperature to the 34°C target appears to predict an unfavorable neurologic outcome.

Introduction

For patients who have been successfully resuscitated after cardiac arrest, therapeutic mild hypothermia increases the rate of a favorable outcome in comparison with standard life support. Randomized controlled trials, however, have not shown evidence of whether the time to target temperature correlates with neurological outcome.[1–4] Registries about the practical use of therapeutic hypothermia have also not found a significant association between the timing of therapeutic hypothermia and final outcome.[5–7] We expected a strong relationship between the time to target temperature (<34°C) and neurological outcome. Furthermore, we hypothesized that earlier achievement of target temperature would not necessarily improve outcome.

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