Abstract
PurposeRecent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome.MethodsWe used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale.ResultsBetween May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome.ConclusionsWe report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in “no flow” duration.
Highlights
Over the last decades, implementation of the “chain of survival” led to a progressive improvement in outcome after cardiac arrest (CA) in many places across the world [1]
Among the interventions that can be provided during the post-resuscitation period, recent data raised some concerns regarding the benefit of targeted temperature management (TTM) for comatose CA survivors
Cardiopulmonary resuscitation was not attempted in 7923 patients, an obvious non-cardiac cause of arrest was evidenced in 3782 patients, resuscitation failed in 8766 patients, and 663 patients with refractory CA were transported without return of spontaneous circulation (ROSC) to the hospital for potential extra-corporeal life support
Summary
Implementation of the “chain of survival” led to a progressive improvement in outcome after cardiac arrest (CA) in many places across the world [1]. In addition to pre-hospital management, postcardiac arrest care is considered as a major determinant of outcome. Among the interventions that can be provided during the post-resuscitation period, recent data raised some concerns regarding the benefit of targeted temperature management (TTM) for comatose CA survivors. The TTM trial that showed no difference between 33 and 36° may have been falsely considered by some clinicians as a negative study regarding the effectiveness of TTM [4]. On the whole, this may have resulted in a change in TTM modalities in post-cardiac patients, as reported by several investigators [5]. Deye et al observed that 37% of responders changed their attitude regarding TTM over the recent years, many of them moving from 33 °C toward a higher temperature level [6]
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