Abstract 331: Whether the Compliance of Target Temperature Management Protocol Affects Outcomes in Cardiac Arrest Survivors?

Abstract

Background: Targeted temperature management (TTM) improves neurological recovery in cardiac arrest survivors and protocols have been established during the implementation of high quality TTM with recommended about cooling rate, duration of maintenance, and rewarming speed. Research question Whether fitting TTM protocols results in better survival and neurological recovery remains un-investigated. Aim: To evaluate the benefit of TTM protocol compliance on the outcomes in cardiac arrest survivors. Methods: The retrospective cohort study enrolled 1141 non-traumatic adult cardiac arrest survivors and pre-arrest Cerebral Performance Category (CPC) score=1-2 during 2015-2020 at a tertiary medical center. Patients who underwent TTM (n=305) were further selected. Patients with spontaneous hypothermia (<35°C) at ROSC (n=107) and those without TTM completion (n=21) were excluded. A total of 202 patients were finally enrolled in the study. As the protocol was divided into three categories: cooling rate, duration of maintenance, and rewarming speed, there were 110 patients in the protocol-fit group and 92 patients in the protocol non-fit group. The favorable neurological recovery was considered as CPC=1-2 at hospital discharge. Results: There were 42 patients (38.2%) in the protocol-fit group had favorable neurological recovery, while 32 patients (34.8%) in the protocol non-fit group. After adjusting age, initial shockable rhythm, witnessed collapse and CPR duration, the protocol non-fit group was associated to the poor neurological outcome (adjusted odds ratio [aOR] 2.44, 95% confidence interval [CI]= 2.23-5.35) but not the in-hospital mortality (aOR 2.31, 95% CI= 0.70-2.47). In the protocol non-fit group, the most common non-fitting reason was the prolong time-to-target temperature (n=33, 58.7%). Twenty-four patients who failed to fit the 2 categories. The number of non-fitting category was not significantly associated with in-hospital mortality and poor neurological recovery due to limited sample number. Conclusion: Among cardiac arrest survivors undergoing TTM, patients who did not fit the TTM protocols were associated with poor neurological recovery than those who completely fit the protocols.