Thermoregulation in post-cardiac arrest patients treated with targeted temperature management

RESUSCITATION

卷:162

Article

Hoeyer-Nielsen, Anne Kirstine^1,4  Holmberg, Mathias J.^2,3,4,5  Christensen, Erika F.¹  Cocchi, Michael N.⁴  Donnino, Michael W.⁴  Grossestreuer, Anne, V⁴ 

[1] Aalborg Univ, Dept Clin Res, Ctr Prehosp & Emergency Res, Aalborg, Denmark

[2] Aarhus Univ, Res Ctr Emergency Med, Dept Clin Med, Aarhus, Denmark

[3] Aarhus Univ Hosp, Aarhus, Denmark

[4] Beth Israel Deaconess Med Ctr, Ctr Resuscitat Sci, Dept Emergency Med, One Deaconess Rd, Boston, MA 02215 USA

[5] Viborg Reg Hosp, Dept Cardiol, Viborg, Denmark

关键词: Heart arrest;    Body temperature regulation;    Rewarming;    Brain injury;    Prognosis;   

DOI  :  10.1016/j.resuscitation.2021.02.005

来源: Elsevier

【 摘 要 】

Objective: Evaluate the relationship between heat generation during rewarming in post-cardiac arrest patients receiving targeted temperature management (TTM) as a surrogate of thermoregulatory ability and clinical outcomes. Methods: This is a prospective observational single-centre study conducted at an urban tertiary-care hospital. We included post-cardiac arrest adults who received TTM via surface cooling device between April 2018 and June 2019. Results: Patient heat generation was calculated by multiplying the inverse of the average machine water temperature with time to rewarm to 37 degrees C and standardized in two ways to account for target temperature variation: (1) divided by number of degrees between target temperature and 37 degrees C, and (2) limited to when patient was rewarmed from 36 degrees C to 37 degrees C. The primary outcome was poor neurologic status, defined as Cerebral Performance Category (CPC) score 3-5, and the secondary outcome was 30-day survival. Sixty-six patients were included: 45 (68%) had a CPC-score of 3-5 and 23 (35%) were alive at 30 days. Besides initial rhythm and arrest downtime, baseline characteristics were similar between outcomes. Heat generation was not associated with poor neurological outcome (CPC 3-5: 6.6 [IQR: 6.1, 7.4] versus CPC 1-2: 6.6 [IQR: 5.7, 7.6], p = 0.89) or survival at 30 days (nonsurvivors: 6.6 [IQR: 6.6, 7.4] vs. survivors: 6.6 [IQR: 5.7, 8.0, p = 0.78]). Conclusion: Heat generation during rewarming was not associated with neurologic outcomes. However, there was a relationship between poor neurological outcome and higher median water temperatures. Time to rewarm was prolonged in patients with poor neurological outcome.

【 授权许可】

Free