Neuromuscular blockade requirement is associated with good neurologic outcome in cardiac arrest survivors treated with targeted temperature management

2017 ◽  
Vol 40 ◽  
pp. 218-224 ◽  
Author(s):  
Dong Hun Lee ◽  
Byung Kook Lee ◽  
Kyung Woon Jeung ◽  
Yong Hun Jung ◽  
Yong Soo Cho ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neuromuscular Blockade ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Good Neurologic Outcome

Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ian R Drennan ◽  
Steve Lin ◽  
Kevin E Thorpe ◽  
Jason E Buick ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Injury ◽  
Good Neurologic Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

Background Frequency Patterns in Standard Electroencephalography During Targeted Temperature Management as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors: a retrospective cohort study

2020 ◽  
Author(s):  
Youn-Jung Kim ◽  
Min-jee Kim ◽  
Yong Seo Koo ◽  
Won Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Clinical Features ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Background Frequency ◽  
Prognostic Tool ◽  
Logistic Analysis ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Abstract Background Electroencephalography is a widely used tool for detecting epileptiform and assessing neurological outcomes after cardiac arrest. We investigated the prognostic value of standard electroencephalography during early post-cardiac arrest period and evaluated the performance of electroencephalography findings combined with other clinical features for predicting good outcome. Methods This observational registry-based study was conducted at tertiary care hospital in Korea. Data of all consecutive adult comatose out-of-hospital cardiac arrest survivors who underwent electroencephalography during targeted temperature management between 2010 and 2018 were extracted. Electroencephalography findings, classified according to the American Clinical Neurophysiological Society critical care electroencephalography terminology, and good neurologic outcome-related clinical features were identified via multivariable logistic analysis. Results Good outcomes were observed in 36.5% of 170 patients. Median electroencephalography time was 22.0 hours. Electroencephalography background, voltage and other findings (burst suppression, reactivity to pain stimuli) significantly differed between good and poor outcome groups. Electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 9.8 (95% confidence interval 3.9-24.9) in multivariable logistic analysis. Electroencephalography background frequency enabled identification of a good neurologic outcome (sensitivity, 83.87%; specificity, 75.93%). Combination of other clinical features (age<65 years, initial shockable rhythm, resuscitation duration<20 min) with electroencephalography findings increased predictive performance for good neurologic outcomes (sensitivity, 95.2%; specificity, 100%). ConclusionsBackground frequency patterns of standard electroencephalography during targeted temperature management may play a role as an early prognostic tool in out-of-hospital cardiac arrest patients.

scholarly journals Optimal Time of Collapse to Return of Spontaneous Circulation to Apply Targeted Temperature Management for Cardiac Arrest: A Bayesian Network Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
Jingwei Duan ◽  
Qiangrong Zhai ◽  
Yuanchao Shi ◽  
Hongxia Ge ◽  
Kang Zheng ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Bayesian Network ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Return Of Spontaneous Circulation ◽  
Neurologic Outcomes ◽  
Good Neurologic Outcome

Background: Both the American Heart Association (AHA) and European Resuscitation Council (ERC) have strongly recommended targeted temperature management (TTM) for patients who remain in coma after return of spontaneous circulation (ROSC). However, the role of TTM, especially hypothermia, in cardiac arrest patients after TTM2 trials has become much uncertain.Methods: We searched four online databases (PubMed, Embase, CENTRAL, and Web of Science) and conducted a Bayesian network meta-analysis. Based on the time of collapse to ROSC and whether the patient received TTM or not, we divided this analysis into eight groups (&lt;20 min + TTM, &lt;20 min, 20–39 min + TTM, 20–39 min, 40–59 min + TTM, 40–59 min, ≥60 min + TTM and ≥60 min) to compare their 30-day and at-discharge survival and neurologic outcomes.Results: From an initial search of 3,023 articles, a total of 9,005 patients from 42 trials were eligible and were included in this network meta-analysis. Compared with other groups, patients in the &lt;20 min + TTM group were more likely to have better survival and good neurologic outcomes (probability = 46.1 and 52.5%, respectively). In comparing the same time groups with and without TTM, only the survival and neurologic outcome of the 20–39 min + TTM group was significantly better than that of the 20–39 min group [odds ratio = 1.41, 95% confidence interval (1.04–1.91); OR = 1.46, 95% CI (1.07–2.00) respectively]. Applying TTM with &lt;20 min or more than 40 min of collapse to ROSC did not improve survival or neurologic outcome [ &lt;20 min vs. &lt;20 min + TTM: OR = 1.02, 95% CI (0.61–1.71)/OR = 1.03, 95% CI (0.61–1.75); 40–59 min vs. 40–59 min + TTM: OR = 1.50, 95% CI (0.97–2.32)/OR = 1.40, 95% CI (0.81–2.44); ≧60 min vs. ≧60 min + TTM: OR = 2.09, 95% CI (0.70–6.24)/OR = 4.14, 95% CI (0.91–18.74), respectively]. Both survival and good neurologic outcome were closely related to the time from collapse to ROSC.Conclusion: Survival and good neurologic outcome are closely associated with the time of collapse to ROSC. These findings supported that 20–40 min of collapse to ROSC should be a more suitable indication for TTM for cardiac arrest patients. Moreover, the future trials should pay more attention to these patients who suffer from moderate injury.Systematic Review Registration: [https://inplasy.com/?s=202180027], identifier [INPLASY202180027]

Abstract 407: Utility of Abnormal Head Computed Tomography in Predicting Outcome in Out of Hospital Cardiac Arrest Victims Resuscitated and Subsequently Placed on Targeted Temperature Management

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Michael Bernett ◽  
Robert A Swor
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Survival Analysis ◽  
Interrater Reliability ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Radiology Reports ◽  
Head Computed Tomography ◽  
Hospital Cardiac Arrest

Introduction: Head computed tomography (HCT) is often performed to assess for hypoxic-ischemic brain injury in resuscitated out of hospital cardiac arrest (OHCA) patients. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome post OHCA. Methods: We included subjects from a prospectively collected cardiac arrest database of OHCA adult patients who received targeted temperature management (TTM) at two academic suburban hospitals from 2009-Sept-2018. Cases were included if a HCT was performed in the emergency department (ED). Patient demographics and cardiac arrest variables were collected. HCT results were abstracted by study authors from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, stroke). Outcomes were survival to discharge or cerebral performance scores (CPC) at discharge of three or four (poor neurologic outcome). Descriptive statistics, univariate, multivariate, survival, and interrater reliability analysis were performed. Results: During the study period, there were 425 OHCA, 277 cases had ED HCTs performed; 254 cases were included in the final survival analysis. Patients were predominately male, 189 (65.0%), average age 60.9 years, average BMI of 30.5. Of all cases, 44 (15.9%) showed CE on CT. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (OR: 9.23; 95% CI 1.73, 49.2), and 9.1-fold greater odds of death (OR: 9.09: 95% CI 2.4 33.9). In adjusted analysis, CE was associated with 14.9-fold greater odds of poor CPC outcome (AOR: 14.9, 95% CI, 2.49, 88.4), and 13.7-fold greater odds of death (AOR: 13.7, 95% CI, 3.26, 57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (HR: 3.56: 95% CI 2.34, 5.41). Interrater reliability demonstrated excellent agreement between reviewers for CE on HCT (κ = 0.86). Conclusion: The results identify that abnormal HCTs early in the post-arrest period in OHCA patients are associated with poor rates of survival and neurologic outcome. Prospective work is needed to confirm whether selection bias or other variables confound this association.

P0250COLD DIURESIS DURING TARGETED TEMPERATURE MANAGEMENT AFTER CARDIAC ARREST, MYTH OR FACT?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Min-Jeong Lee ◽  
Minjung Kathy Chae
Keyword(s):  
Cardiac Arrest ◽  
Body Temperature ◽  
Therapeutic Hypothermia ◽  
Urine Output ◽  
The Body ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Induction Phase ◽  
Target Temperature

Abstract Background and Aims Therapeutic hypothermia or targeted temperature management (TTM) has been standard treatment for cardiac arrest survivors with suspected hypoxic ischemic brain injury for improvement in both survival and neurological outcomes. TTM is consisted of an induction phase of quickly lowering the temperature to target temperature (ranging from 32°C -36°C) as soon as possible, a hypothermia maintenance phase of keeping the body temperature at target temperature for at least 24 hours, a rewarming phase of slowly rewarming the temperature to normothermia, and a normothermia phase of keeping the body temperature at normothermia. During the dynamic changes in body temperature, cold-diuresis is a commonly described phenomenon. However, limited studies have characterized cold-induced diuresis during TTM. In this study, we sought to determine urine output changes during post cardiac arrest therapeutic hypothermia. Method This retrospective cohort study included adult patients who underwent TTM after out-of-hospital cardiac arrest and were admitted to the intensive care unit for post cardiac arrest care between January 2012 and August 2018. The exclusion criteria of this study were as follows: 1) deceased status before the completion of all phase of TTM; 2) previous end stage kidney disease patients, 3) undergoing renal replacement therapy due to AKI within 48 hours of TTM termination; 4) terminal cancer less than 6 months of life expectancy or previously cerebral performance category (CPC) 3 or more. The neurologic outcome was assessed using the CPC score after 1 month. Good neurologic outcome was defined as a CPC score of 1, 2 and poor neurologic outcome as a CPC score of 3 to 5. The post cardiac arrest protocol recommends a target temperature of 33°C unless the patient is hemodynamically unstable or has a bleeding tendency or severe infection. Rewarming rate was 0.15°C/hr or 0.25°C/hr. TTM was conducted with the use of temperature managing devices with a feedback loop system (Artic Sun Energy Transfer Pads, Medivance Corp., Louisville, CO, USA; Cool Guard Alsius Icy Heat Exchange Catheter, Alsius Corporation, Irvine, CA, USA). We calculated the hourly IV fluid input and urine output rates for each TTM phase. To compare the mean of urine volume between each TTM phase, we used repeated measure analysis of variance (ANOVA). Results 178 Patients included in the analysis. We observed a increase in urine output rates during hypothermia induction. This effect persisted even after adjustment for variable clinical confounders, including intravenous fluid input rate, mean arterial pressure (MAP), initial shockable rhythm, SOFA score, body mass index, and IV furosemide use. However, we did not detect any evidence of urine output increases or decreases during the hypothermia maintenance or rewarming phases. By repeating measures ANOVA and a linear mixed model, it was confirmed that there is a difference in urine output for each TTM phase. Even after the post hoc analysis was calibrated with several variables, only the hypotheria induction phase differed significantly from the urine output of the phase. Conclusion Although our results are some limitations, the findings support the potential presence of cold-induced dieresis, but not rewarm anti-diuresis during TTM. Our study may not fully capture the extent of renal impairment in post cardiac arrest undergoing TTM. However, our objective was to characterize urine output during TTM in post cardiac arrest patients. This has important implications for fluid management in patients undergoing TTM.

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