Abstract 150: Non-Linear Association Between the Time of Reaching the Targeted Temperature and the Neurological Outcome in Patients Undergoing Targeted Temperature Management After Out-of-Hospital Cardiac Arrest Observational Multicenter Cohort Study

Abstract

Background: We aimed to identify the most favourable time from the introduction of targeted temperature management (TTM) to achieving the targeted temperature in patients experiencing out-of-hospital cardiac arrest. Methods: This multicenter cohort study was performed using the Comprehensive Registry of Intensive Care for OHCA Survival study, we collected patients’ information, including that on in-hospital care. We enrolled all consecutive patients transported to participating institutions in Osaka, Japan from 1 July 2012 through 31 December 2017. Eligible were persons aged ≥18 years whose cardiac arrest was of cardiac etiology and who received in-hospital TTM. Primary outcome was favourable neurological survival with a Cerebral Performance Category scale of 1 or 2 one-month after cardiac arrest, which was designated as “one-month favourable neurological survival”. After adjusting for several factors, a non-linear multivariable logistic regression analysis assessed the time from the introduction of TTM to reaching the targeted temperature and the probability of the primary outcome. Also, we subdivided patients according to five quintiles based on the time from the introduction of TTM to achieving the targeted temperature. To compare the probability of the primary outcome among quintiles, a multivariable logistic regression analysis calculated adjusted odds ratios and 95% confidence intervals. Results: We analyzed 483 patients. p for non-linearity was <0.01 in the non-linear multivariable logistic regression analysis. In the first quintile (<26.7 minutes), second quintile (26.8-89.9 minutes), third quintile (90.0-175.1 minutes), fourth quintile (175.2-352.1 minutes), and fifth quintile (≥352.2 minutes), one-month favourable neurological survival was 32.6% (31/95), 40.0% (36/90), 53.5% (53/99), 57.4% (54/94), and 37.9% (36/95), respectively. Adjusted odds ratios with 95% CI for the primary outcome in the first, second, third, and fifth quintiles, compared with the fourth quintile as the reference, were 0.38 (0.20 to 0.72), 0.43 (0.23 to 0.81), 0.77 (0.41 to 1.44), and 0.46 (0.25 to 0.87), respectively. Conclusions: Time to reaching the targeted temperature was associated with favourable outcome in patients with cardiac arrest.