Abstract 220: More Patience to the Patient? -The Timing of Initiating Targeted Temperature Management

Abstract

Introduction: The timing of Targeted Temperature Management (TTM) after Return of spontaneous circulation (ROSC) is controversial. Spontaneous neurological recovery can avoid the resource-wasting and adverse events of TTM. The purpose of this study is to determine the percentage of spontaneous recovery in a three-hour interval post ROSC, and to predict factors of recovery to Glasgow-Coma-Scale (GCS) Motor response 6 (M6). Hypothesis: Some patients may recover to GCS M6 in the early post ROSC period. These patients may also have favorable neurological outcome at discharge. Methods: This was a single center observational study which enrolled 541 patients with ROSC after OHCA. We recorded the motor response post ROSC, the motor response at 3hr, the patients’ characteristics, and resuscitation variables. Predictors of GCS M6 were assessed by multiple logistic regression analysis. Results: Graph 1 showed the number of patients with motor response change in a three-hour interval. All 96 patients with GCS M6 at 3hr had favorable neurological outcome, except 6 died from cardiogenic shock and 7 died from terminal cancer status. GCS M6 at 3hr, instead of GCS M6 post ROSC, was a predictor for favorable neurological outcome (OR, 2.09; 95%CI, 1.80-2.42; P= 0.0001) when adjusted with demographic and resuscitation variables. There were three factors predicting the GCS M6 at 3hr, including the cumulative epinephrine dose (OR, 0.81; 95% CI, 0.70 - 0.93; P=0.003), the CPR duration (OR, 0.957; 95% CI, 0.93 -0.98; P=0.001), and the initial shockable rhythm (OR, 4.41; 95% CI, 2.44 - 7.85; P=0.0001). Conclusions: A significant portion of patients had spontaneous recovery to GCS M6 within 3 hours, and had favorable neurological outcome. Certain factors could be used to predict the recovery in early post ROSC period. The optimal timing of TTM could be re-evaluated. Close monitoring GCS together with appropriate usage of sedation are critical for patients with higher chance of neurological recovery.