Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

Josef Dankiewicz; Hans Friberg; Jan Bělohlávek; Andrew Walden; Christian Hassager; Tobias Cronberg; David Erlinge; Yvan Gasche; Jan Hovdenes; Janneke Horn; Jesper Kjaergaard; Michael Kuiper; Thomas Pellis; Pascal Stammet; Michael Wanscher; Jørn Wetterslev; Matthew Wise; Anders Åneman; Niklas Nielsen

doi:10.1016/j.resuscitation.2015.10.013

Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

Josef Dankiewicz, Hans Friberg, Jan Bělohlávek, Andrew Walden, Christian Hassager, Tobias Cronberg, David Erlinge, Yvan Gasche, Jan Hovdenes, Janneke Horn, Jesper Kjaergaard, Michael Kuiper, Thomas Pellis, Pascal Stammet, Michael Wanscher, Jørn Wetterslev, Matthew Wise, Anders Åneman, Niklas Nielsen

Copenhagen Trial Unit Rigshospitalet

13 Citationer (Scopus)

Abstract

INTRODUCTION: The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature management at lower temperatures.

METHODS: We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33°C and 36°C for an interaction between no-flow time and intervention group, with neurological function at six months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome.

RESULTS: No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p<0.001). There was no statistically significant interaction between no flow-time and intervention group (p=0.11), which may imply that the non-superior effect of 33°C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function.

CONCLUSIONS: TTM at 33°C compared to 36°C was not associated with an increased probability of a good neurological function for patients with longer no-flow times.

Originalsprog	Engelsk
Tidsskrift	Resuscitation
Vol/bind	99
Sider (fra-til)	44-49
ISSN	0300-9572
DOI	https://doi.org/10.1016/j.resuscitation.2015.10.013
Status	Udgivet - 2016

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10.1016/j.resuscitation.2015.10.013

Citationsformater

Dankiewicz, J., Friberg, H., Bělohlávek, J., Walden, A., Hassager, C., Cronberg, T., Erlinge, D., Gasche, Y., Hovdenes, J., Horn, J., Kjaergaard, J., Kuiper, M., Pellis, T., Stammet, P., Wanscher, M., Wetterslev, J., Wise, M., Åneman, A., & Nielsen, N. (2016). Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C. Resuscitation, 99, 44-49. https://doi.org/10.1016/j.resuscitation.2015.10.013

Dankiewicz, J, Friberg, H, Bělohlávek, J, Walden, A, Hassager, C, Cronberg, T, Erlinge, D, Gasche, Y, Hovdenes, J, Horn, J, Kjaergaard, J, Kuiper, M, Pellis, T, Stammet, P, Wanscher, M, Wetterslev, J, Wise, M, Åneman, A & Nielsen, N 2016, 'Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C', Resuscitation, bind 99, s. 44-49. https://doi.org/10.1016/j.resuscitation.2015.10.013

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title = "Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C",

abstract = "INTRODUCTION: The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature management at lower temperatures.METHODS: We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33°C and 36°C for an interaction between no-flow time and intervention group, with neurological function at six months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome.RESULTS: No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p<0.001). There was no statistically significant interaction between no flow-time and intervention group (p=0.11), which may imply that the non-superior effect of 33°C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function.CONCLUSIONS: TTM at 33°C compared to 36°C was not associated with an increased probability of a good neurological function for patients with longer no-flow times.",

author = "Josef Dankiewicz and Hans Friberg and Jan B{\v e}lohl{\'a}vek and Andrew Walden and Christian Hassager and Tobias Cronberg and David Erlinge and Yvan Gasche and Jan Hovdenes and Janneke Horn and Jesper Kjaergaard and Michael Kuiper and Thomas Pellis and Pascal Stammet and Michael Wanscher and J{\o}rn Wetterslev and Matthew Wise and Anders {\AA}neman and Niklas Nielsen",

year = "2016",

doi = "10.1016/j.resuscitation.2015.10.013",

language = "English",

volume = "99",

pages = "44--49",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

AU - Dankiewicz, Josef

AU - Friberg, Hans

AU - Bělohlávek, Jan

AU - Walden, Andrew

AU - Hassager, Christian

AU - Cronberg, Tobias

AU - Erlinge, David

AU - Gasche, Yvan

AU - Hovdenes, Jan

AU - Horn, Janneke

AU - Kjaergaard, Jesper

AU - Kuiper, Michael

AU - Pellis, Thomas

AU - Stammet, Pascal

AU - Wanscher, Michael

AU - Wetterslev, Jørn

AU - Wise, Matthew

AU - Åneman, Anders

AU - Nielsen, Niklas

PY - 2016

Y1 - 2016

N2 - INTRODUCTION: The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature management at lower temperatures.METHODS: We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33°C and 36°C for an interaction between no-flow time and intervention group, with neurological function at six months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome.RESULTS: No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p<0.001). There was no statistically significant interaction between no flow-time and intervention group (p=0.11), which may imply that the non-superior effect of 33°C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function.CONCLUSIONS: TTM at 33°C compared to 36°C was not associated with an increased probability of a good neurological function for patients with longer no-flow times.

AB - INTRODUCTION: The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature management at lower temperatures.METHODS: We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33°C and 36°C for an interaction between no-flow time and intervention group, with neurological function at six months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome.RESULTS: No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p<0.001). There was no statistically significant interaction between no flow-time and intervention group (p=0.11), which may imply that the non-superior effect of 33°C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function.CONCLUSIONS: TTM at 33°C compared to 36°C was not associated with an increased probability of a good neurological function for patients with longer no-flow times.

U2 - 10.1016/j.resuscitation.2015.10.013

DO - 10.1016/j.resuscitation.2015.10.013

M3 - Journal article

C2 - 26705972

SN - 0300-9572

VL - 99

SP - 44

EP - 49

JO - Resuscitation

JF - Resuscitation

ER -

Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

Abstract

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