The Effect of Targeted Temperature Management on Five-Year Mortality in Comatose Out-of-Hospital Cardiac Arrest Survivors: A Real-World Experience
Recommended Citation
Tajlil A, Abdelradi A, Mosleh W, Kattel S, Al Jebaje Z, Sharma U. The Effect of Targeted Temperature Management on Five-Year Mortality in Comatose Out-of-Hospital Cardiac Arrest Survivors: A Real-World Experience. Circulation 2024; 150.
Document Type
Conference Proceeding
Publication Date
11-11-2024
Publication Title
Circulation
Keywords
adult, body temperature, cohort analysis, coma, comatose patient, comorbidity, conference abstract, controlled study, cooling, cooling system, coronary artery disease, female, heart arrest, heart disease, human, induced hypothermia, long term survival, major clinical study, male, mortality, neuroprotection, out of hospital cardiac arrest, return of spontaneous circulation, short term survival, surgery, survivor, warming
Abstract
Background: Hypothermia-Induced Targeted Temperature Management (TTM) is a neuroprotective treatment after the return of spontaneous circulation (ROSC) in comatose survivors of out-of-hospital cardiac arrest (OHCA). However, its effectiveness in all patient subpopulations is debated. While short-term survival has been well studied, the impact of TTM on long-term survival is still unknown. Methods: In a prospective cohort study, 98 comatose survivors of non-traumatic OHCA were recruited from four tertiary-level hospitals in Buffalo, Western New York and followed up for five years. Patients with active cancer, infection, cardiac pathology or surgery in three-month prior to presentation, were excluded. Cardiac arrest characteristics, demographics, comorbidities, and therapeutic interventions were recorded. According to TTM protocols, a target body temperature of 33°C was reached and maintained for 24 hours using either an intravascular cooling catheter or a surface cooling system. This was followed by gradual controlled rewarming over 12- 24 hours to normothermia. Factors associated with the receipt of TTM were determined. The effect of TTM on five-year survival was studied using cox-regression analysis. Results: Among comatose patients with mean age of 60.1±14.9 years, 49% received TTM. Females were significantly less likely to receive TTM (35.1% vs 59.3%, p=0.021). In TTM group, the time to ROSC was significantly longer: median [IQR] 14.5 mins (5-19.7) vs 20 mins (12-27), p=0.018. TTM group was more likely to have a history of coronary artery disease (CAD) (12.5% vs 35.4%, p=0.009). Overall, 5-year mortality did not differ significantly between TTM vs. non-TTM: 72.9% vs 66.0%, (HR: 1.134, 95% CI: 0.705-1.826, p=0.603) in univariate and multivariate Cox-regression analysis (Table 1). Conclusion: While females are less likely to receive TTM treatment, TTM is more likely to be used in patients with a longer time to ROSC and a history of CAD. The overall five-year survival remains high in both treatment groups in all eligible patients, as well as in shockable and non-shockable rhythm groups studied separately. Larger cohort studies are needed to determine the patients who may benefit most from TTM. (Figure Presented).
Volume
150
