The association of targeted temperature management at 33 and 36 °C with outcome in patients with moderate shock on admission after out-of-hospital cardiac arrest: a post hoc analysis of the Target Temperature Management trial.

Abstract

PURPOSE:

We hypothesized that a targeted temperature of 33 °C as compared to that of 36 °C would increase survival and reduce the severity of circulatory shock in patients with shock on admission after out-of-hospital cardiac arrest (OHCA).

METHODS:

The recently published Target Temperature Management trial (TTM-trial) randomized 939 OHCA patients with no difference in outcome between groups and no difference in mortality at the end of the trial in a predefined subgroup of patients with shock at admission. Shock was defined as a systolic blood pressure of <90 mm Hg for >30 min or the need of supportive measures to maintain a blood pressure ≥90 mmHg and/or clinical signs of end-organ hypoperfusion. In this post hoc analysis reported here, we further analyzed the 139 patients with shock at admission; all had been randomized to receive intervention at 33 °C (TTM33; n = 71) or 36 °C (TTM36; n = 68). Primary outcome was 180-day mortality. Secondary outcomes were intensive care unit (ICU) and 30-day mortality, severity of circulatory shock assessed by mean arterial pressure, serum lactate, fluid balance and the extended Sequential Organ Failure assessment (SOFA) score.

RESULTS:

There was no significance difference between targeted temperature management at 33 °C or 36 °C on 180-day mortality [log-rank test, p = 0.17, hazard ratio 1.33, 95 % confidence interval (CI) 0.88-1.98] or ICU mortality (61 vs. 44 %, p = 0.06; relative risk 1.37, 95 % CI 0.99-1.91). Serum lactate and the extended cardiovascular SOFA score were higher in the TTM33 group (p < 0.01).

CONCLUSIONS:

We found no benefit in survival or severity of circulatory shock with targeted temperature management at 33 °C as compared to 36 °C in patients with shock on admission after OHCA.

• Authors: Martin Annborn, John Bro-Jeppesen, Niklas Nielsen, Susann Ullén, Jesper Kjaergaard, Christian Hassager, Michael Wanscher, Jan Hovdenes, Tommaso Pellis, Paolo Pelosi, Matt P Wise, Tobias Cronberg, David Erlinge, Hans Friberg, TTM-trial investigators
• Journal: Intensive care medicine (Intensive Care Med) Vol. 40 Issue 9 Pg. 1210-9 (Sep 2014) ISSN: 1432-1238 [Electronic] United States
• PMID: 25001475 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Body Temperature
• Female
• Hospitalization
• Humans
• Hypothermia, Induced (standards)
• Male
• Middle Aged
• Out-of-Hospital Cardiac Arrest (complications, therapy)
• Severity of Illness Index
• Shock (etiology, therapy)