Abstract 431: Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest and Prolonged Mechanical Ventilation Period: Insight From the National Inpatient Sample Database 2019

Abstract

Introduction: The TTM2 trial showed that targeted temperature management (TTM) did not improve the functional status of survivors of out-of-hospital cardiac arrest (OHCA). However, the TTM2 trial OHCA survivors cohort had short mechanical ventilation (MV) duration (3.8 days in the hypothermic group and 2.9 days in the normothermic group). Aims: We aimed to investigate the functional status of OHCA survivors who required a prolonged MV duration. Methods: We utilized the National Inpatient Sample Database 2019. Participants were included if they were primarily admitted for cardiac arrest regardless of initial rhythm. Prolonged MV was defined as > 4 days. Patients who have ICD-10 codes for both short and prolonged MV durations were excluded as they potentially had multiple intubations. The primary outcome was discharge from the hospital to home, as a surrogate for good functional status on discharge. Results: A total of 28,890 patients were admitted for cardiac arrest in 2019 in the United States. Of them, 67.5% (n=19,515) had MV. Of the mechanically ventilated patients, 74.3% (n=14,490) were ventilated for ≤ 4 days, 24.8% (n=4,835) had prolonged MV, and 190 admissions were excluded for possible multiple MV episodes. TTM utilization was comparable between survivors with prolonged MV (8.7%, n=200) and short MV (7.6%, n=380)(p=0.083). Discharge to home was higher in the short MV group [33.8% (n=1,690) vs 15% (n=345), p<0.001]. After adjusting for age, sex, race, insurance, Elixhauser comorbidity index, renal replacement therapy, and coronary angiography, TTM was not independently associated with discharge to home in the short MV group (aOR 0.951, 95% CI 1.008-0.795, p=0.992). However, TTM was associated with significantly higher odds of discharge to home in the prolonged MV group (aOR 2.441, 95% CI 1.591-3.744, p<0.001). Conclusions: One-fourth of the OHCA survivors, mechanically ventilated, cohort required prolonged MV. These patients have poorer functional status (discharge to home rate) that the short MV cohort. TTM seems to correlate with improved adjusted functional status on discharge from the hospital in the prolonged MV group. Future clinical trials should investigate the TTM impact on this subgroup of OHCA survivors.