دورية
Abstract 30: Targeted Temperature Management at 33 versus 36 Degrees: Outcomes After Real-World Implementation
| العنوان: | Abstract 30: Targeted Temperature Management at 33 versus 36 Degrees: Outcomes After Real-World Implementation |
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| المؤلفون: | Johnson, Nicholas J, Danielson, Kyle R, Counts, Catherine R, Ruark, Katelyn, Scruggs, Sue, Hough, Catherine L, Maynard, Charles, Sayre, Michael, Carlbom, David |
| المصدر: | Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 2 pA30-A30, 1p |
| مستخلص: | Objective:To determine the association between targeted temperature management (TTM) goal temperature of 33 versus 36?C and neurologic outcome after out-of-hospital cardiac arrest (OHCA).Methods:This was a retrospective, before-and-after, cohort study conducted at an urban, academic, Level 1 trauma center from 2010-2017. We included adults with non-traumatic OHCA who received TTM. Our primary exposure was TTM goal temperature, which was changed from 33 to 36?C in April of 2014 at the study hospital. Primary outcome was neurologically-intact survival to discharge. Secondary outcomes included hospital mortality and care processes. We used univariate analysis and multivariate logistic regression to examined the association between TTM goal and outcome.Results:Of 782 OHCA patients transported to the study hospital, 453 (58%) received TTM. Of these, 258 (57%) were treated during the 33?C period (TTM33) and 195 (43%) were treated during the 36?C period (TTM36). Patients treated during TTM33 were older (57 vs. 52 years, p<0.05) and had more arrests of cardiac etiology (45 vs. 35%, p <0.05), but otherwise had similar baseline characteristics, including initial rhythm. 40% of patients treated during TTM33 survived with favorable neurologic outcome, compared with 30% in the TTM36 group (p<0.05). After adjustment for demographic and cardiac arrest characteristics, TTM33 was associated with increased odds of neurologically-intact survival to discharge (OR 1.79, 95% CI 1.09-2.94). TTM33 was not associated with significantly improved hospital mortality. TTM was implemented faster (1.9 vs 3.5 hours from 911 call, p<0.001) and more frequently in the emergency department during the TTM33 period. (87 vs. 55%, p<0.001)Conclusion:Comatose, adult OHCA patients treated during the TTM33 period had higher odds of neurologically-intact survival to hospital discharge compared with those treated during the TTM36 period. Our findings may be explained by earlier and more aggressive TTM implementation during the TTM33 period, secular changes in patient characteristics or care, or a biological effect of lower temperature not detected in recent trials. |
| قاعدة البيانات: | Supplemental Index |
Full Text Finder | تدمد: | 00097322 15244539 |
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| DOI: | 10.1161/circ.140.suppl_2.30 |