Targeted temperature management after resuscitated cardiac arrest: survival and neurological outcome at follow-up

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background According to the most recent resuscitation guidelines, targeted temperature management (TTM) is recommended for comatous patients after resuscitated cardiac arrest (CA). Some studies have shown benefitial effects on survival in shockable rhythm as well as an improvement on neurological outcome regardless of the initial rhythm. Nevertheless there is less information about long term outcome of these patients. Purpose This study aims to analyse survival and neurological prognosis after discharge as well as the readmission rates in patients who received TTM in our Coronary Care Unit (CCU). Methods Retrospective cohort of 188 patients admitted at our CCU from 2006-2021 in coma (Glasgow Coma Scale ≤10) after resuscitated CA. TTM with a target core temperature of 33ºC was applied for 24 hours in all comatous patients since 2011, with intravascular cooling catheter. We assessed mortality, neurological outcome at 1 year and readmissions after discharge in those treated with TTM. We evaluated neurological outcome with the Cerebral Performance Categories Scale (CPC), which considers CPC 1-2 as favourable neurological outcome – survival without severe cerebral disability. We also performed a multivariate analysis to identify predictive factors of mortality, CPC 1-2 and readmissions at follow-up. Results TTM was applied in 75 patients, 63% of them presented with initial shockable rhythm and 37% with non-shockable rhythm. 43 patients were discharged, which represents an intrahospital mortality of 43%. Good neurological outcome at discharge was 49%. The median of the follow-up was 29.5 months (6.4-68.4 months). Mortality after discharge was 5% and the readmission rate was 10%. Moreover 22% of all patients remained with severe neurological impairment at 1 year. We performed a multivariate analysis of all comatous patients who were discharged and observed a tendency towards lower mortality after discharge in patients who had been treated with TTM (p=0.071). Neurological outcome at 1 year was significantly associated with early awakening -before 5th day- (p=0.042). We didn’t identify any predictive factors of readmission. Conclusions Even though mortality in comatous patients after CA is high, those who were treated with TTM in our centre and discharged had low mortality and readmission rates on the follow up. The proportion of severe neurological impairment at 1 year remained similar to the proportion we observed at discharge and was significantly associated with early awakening.