J Korean Soc Emerg Med.  2019 Jun;30(3):208-216. 10.0000/jksem.2019.30.3.208.

Targeted temperature management is related to improved clinical outcome of out-of-hospital cardiac arrest with non-shockable initial rhythm

Affiliations
  • 1Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhchoimd@gmail.com

Abstract


OBJECTIVE
The benefits of targeted temperature management (TTM) for resuscitated out of hospital cardiac arrest (OHCA) with an initial non-shockable rhythm are still unclear. This study examined whether TTM reduces the mortality and improves the neurological outcomes of OHCA with a non-shockable initial rhythm.
METHODS
This study analyzed the clinical outcome of 401 resuscitated patients with an initial non-shockable rhythm among a total of 1,616 OHCA patients who were registered in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance. The impact of TTM was investigated after accounting for the patients' propensity for TTM. The primary outcome was a 30-day in-hospital course with a neurologically favorable outcome defined by a cerebral performance categories scale ≤2.
RESULTS
TTM was performed in 89 patients (22%) with an initial non-shockable rhythm. Patients who has received TTM had a tendency to be younger, more likely to be female, and more likely to undergo percutaneous coronary intervention. The clinical outcome of the patients in the initial non-shockable rhythm treated by TTM was superior to those without TTM (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.27-0.46). Further analysis after propensity score matching or inverse probability of treatment weighting (IPTW) showed consistent findings (propensity score matching: HR, 0.32; 95% CI, 0.22-0.45; IPTW: HR, 0.40; 95% CI, 0.31-0.52; P<0.001, all).
CONCLUSION
In this nationwide OHCA registry, TTM was related to an approximately three-fold better 30-day neurologically favorable survival of resuscitated patients with TTM treatment than patients without TTM in the initial non-shockable rhythm.

Keyword

Out-of-hospital cardiac arrest; Induced hypothermia; Cardiopulmonary resuscitation; Prognosis

MeSH Terms

Cardiopulmonary Resuscitation
Epidemiological Monitoring
Female
Heart Arrest
Humans
Hypothermia, Induced
Mortality
Out-of-Hospital Cardiac Arrest*
Percutaneous Coronary Intervention
Prognosis
Propensity Score
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