Abstract 17105: Higher Maximum Temperatures Associated With Worse Outcomes in Patients With Pyrexia Following Rewarming From Post-arrest Targeted Temperature Management

Abstract

Listen

Translate article

Background: Post-arrest pyrexia has been associated with worse outcomes in recent clinical studies. While TTM serves as prophylaxis against pyrexia during active temperature management, it remains unknown to what extent the degree of post-TTM pyrexia relates to survival and neurologic outcomes. We sought to evaluate the association between outcomes and maximum temperature (Tmax) within 72 hours post-rewarming in patients who had Tmax≥38 °C. Hypothesis: We hypothesized that increased Tmax a patient with pyrexia reaches in 72h after TTM discontinuation is associated with worse neurologic and survival outcomes. Methods: We identified 382 TTM-treated patients treated at 14 hospitals between 2005-2014 who had out-of-hospital arrests and serial temperatures recorded during the 72h after returning to normothermia (≥36.5 °C) post-TTM. Our primary outcome was neurologic status (Cerebral Performance Category (CPC) score dichotomized into “good” (1-2) and “poor” (3-5)). Highest recorded temperature in 72h post-TTM after returning to a temperature ≥36.5°C was Tmax. Multiple imputation was used to manage covariate missingness. Results: 147 (39%) patients had documented pyrexia within 72h post-rewarming. In patients with pyrexia, 60% were male, 44% had initial pulseless rhythm of VF/VT, median duration of arrest was 20 (IQR: 13, 30) mins, 49% survived to hospital discharge, and 52 (36%) had a CPC score 1-2 at hospital discharge. Tmax ranged from 38.0-42.2°C, with mean Tmax of 38.7±0.7°C. Median time to Tmax was 19h (IQR: 8, 42). In univariate analysis, higher Tmax was associated with worse neurologic outcomes (OR: 0.38 (95% CI: 0.18-0.80); p=0.01) and survival (OR: 0.41 (95% CI: 0.22-0.79); p=0.01). When controlling for year of arrest, hospital, initial rhythm, sex, witnessed arrest, arrest duration, and age, this relationship was still significant, with each increase in 1°C corresponding to 77% reduction in odds of having good neurologic outcome (aOR: 0.23 (95% CI: 0.08-0.67); p=0.007) and 65% reduction in odds of surviving to hospital discharge (aOR: 0.35 (95% CI: 0.15-0.82); p=0.015). Conclusion: Increased maximum temperature in patients with pyrexia post-rewarming is associated with increased likelihood of poor neurologic and survival outcomes.