Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets

Jean Baptiste Lascarrou; Florence Dumas; Wulfran Bougouin; Stephane Legriel; Nadia Aissaoui; Nicolas Deye; Frankie Beganton; Lionel Lamhaut; Daniel Jost; Antoine Vieillard-Baron; Graham Nichol; Eloi Marijon; Xavier Jouven; Alain Cariou; SDEC Investigators

doi:10.1016/j.chest.2022.10.023

Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets

Chest. 2023 May;163(5):1120-1129. doi: 10.1016/j.chest.2022.10.023. Epub 2022 Oct 30.

Authors

Collaborators

SDEC Investigators:
F Adnet, J M Agostinucci, N Aissaoui-Balanant, V Algalarrondo, F Alla, C Alonso, W Amara, D Annane, C Antoine, P Aubry, E Azoulay, F Beganton, C Billon, W Bougouin, J Boutet, C Bruel, P Bruneval, A Cariou, P Carli, E Casalino, C Cerf, A Chaib, B Cholley, Y Cohen, A Combes, J M Coulaud, D Da Silva, V Das, A Demoule, I Denjoy, N Deye, J L Diehl, S Dinanian, L Domanski, D Dreyfuss, J L Dubois-Rande, F Dumas, J Duranteau, J P Empana, F Extramiana, J Y Fagon, M Fartoukh, F Fieux, E Gandjbakhch, G Geri, B Guidet, F Halimi, P Henry, P Jabre, L Joseph, D Jost, X Jouven, N Karam, J Lacotte, K Lahlou-Laforet, L Lamhaut, A Lanceleur, O Langeron, T Lavergne, E Lecarpentier, A Leenhardt, N Lellouche, V Lemiale, F Lemoine, F Linval, T Loeb, B Ludes, C E Luyt, N Mansencal, N Mansouri, E Marijon, E Maury, V Maxime, B Megarbane, A Mekontso-Dessap, H Mentec, J P Mira, X Monnet, K Narayanan, N Ngoyi, M C Perier, O Piot, P Plaisance, B Plaud, I Plu, J H Raphalen, M Raux, F Revaux, J D Ricard, C Richard, B Riou, F Roussin, F Santoli, F Schortgen, T Sharshar, G Sideris, C Spaulding, J L Teboul, J F Timsit, J P Tourtier, P Tuppin, C Ursat, O Varenne, A Vieillard-Baron, S Voicu, K Wahbi, V Waldmann

Affiliations

¹ Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France. Electronic address: jeanbaptiste.lascarrou@chu-nantes.fr.
² Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France.
³ Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France.
⁴ Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France.
⁵ Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France.
⁶ AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France.
⁷ Université Paris Cité, INSERM, PARCC, Paris, France.
⁸ AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France.
⁹ Brigade des Sapeurs-Pompiers de Paris, Paris, France.
¹⁰ Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France.
¹¹ University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA.

PMID: 36445800
DOI: 10.1016/j.chest.2022.10.023

Abstract

Background: Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated.

Research question: Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score?

Study design and methods: Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set.

Results: A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets.

Interpretation: TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.

Keywords: cardiac arrest; induced hypothermia; targeted temperature management.

MeSH terms

Cardiopulmonary Resuscitation* / methods
Humans
Hypothermia, Induced* / adverse effects
Hypothermia, Induced* / methods
Out-of-Hospital Cardiac Arrest* / complications
Patient Acuity
Prognosis