Abstract
We investigated the association between post-rewarming fever (PRF) and 6-month neurologic outcomes in cardiac arrest survivors. This was a multicenter study based on a registry of comatose adult (≥18 years) out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management between October 2015 to December 2018. PRF was defined as peak temperature ≥ 38.0 °C within 72 h after completion of rewarming, and PRF timing was categorized as within 24, 24–48, and 48–72 h epochs. The primary outcome was neurologic outcomes at six months after cardiac arrest. Unfavorable neurologic outcome was defined as cerebral performance categories three to five. A total of 1031 patients were included, and 642 (62.3%) had unfavorable neurologic outcomes. PRF developed in 389 (37.7%) patients in 72 h after rewarming: within 24 h in 150 (38.6%), in 24–48 h in 155 (39.8%), and in 48–72 h in 84 (21.6%). PRF was associated with improved neurologic outcomes (odds ratio (OR), 0.633; 95% confidence interval (CI), 0.416–0.963). PRF within 24 h (OR, 0.355; 95% CI, 0.191–0.659), but not in 24–48 h or 48–72 h, was associated with unfavorable neurologic outcomes. Early PRF within 24 h after rewarming was associated with favorable neurologic outcomes.
Highlights
Fever or thermogenesis to maintain body temperature is a physiological reaction and important vital sign that is controlled by neuro-hormonal mechanisms to protect the body [1]
Several studies failed to show the association between post-rewarming fever (PRF) and prognosis [14,15,16,17,18], whereas one observational study found that PRF within 48 h after temperature management (TTM) was associated with favorable neurologic outcomes [19]
A total of 1373 of-hospital cardiac arrest survivors (OHCA) survivors who underwent TTM were registered in the KORHN-PRO Jr.eCgliins.tMrye.d.O20f2t0h, o9,sxe,FO20R3PpEEaRtieRnEVtsIEwWere prematurely withdrawn from TTM, 78 died or were discha4rogfe1d4
Summary
Fever or thermogenesis to maintain body temperature is a physiological reaction and important vital sign that is controlled by neuro-hormonal mechanisms to protect the body [1]. Fever or elevated temperature is frequently observed after return of spontaneous circulation (ROSC) in cardiac arrest survivors and is associated with worse neurologic outcomes [2,3,4,5]. Two landmark clinical trials proved that therapeutic hypothermia (TH) improves neurologic outcomes of comatose out-of-hospital cardiac arrest survivors (OHCA) [6,7]. The impact of post-rewarming fever (PRF) that develops after the completion of TTM is inconclusive, experts recommend controlling the PRF [10,11,12,13,14,15,16,17,18,19]. Previous studies have analyzed mixed cohorts of OHCA and in-hospital cardiac arrest (IHCA) [13], included single-center populations [11,14,15,16,17], or used short-term clinical outcomes [12,13,14,15,16,17,18,19]
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