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Targeted temperature management does not affect cognition, quality of life after cardiac arrest
Patients with out-of-hospital cardiac arrest who received targeted temperature management at 33°C or 36°C had similar cognitive function and quality of life, according to new data from the Targeted Temperature Management trial.
Researchers conducted a parallel-group, assessor-masked, randomized clinical trial from Nov. 11, 2010, to Jan. 10, 2013, of 939 unconscious adults with cardiac arrest of presumed cardiac cause. Patients were randomly assigned to targeted temperature management at 33°C or 36°C. Follow-up occurred at 6 months for outcomes including cognitive function, daily life activities, mental recovery and quality of life.
Previously published results indicated no difference between the groups in mortality, Cerebral Performance Category score or modified Rankin scale score.
Cognitive scores similar
In the intention-to-treat population including nonsurvivors of cardiac arrest, the median Mini-Mental State Examination score for assessment of cognitive function was 14 (interquartile range, 0-28) for patients in the 33°C group vs. 17 (interquartile range, 0-29) in the 36°C group (P = .77). Inclusion of only survivors did not change the results (P = .61). The median Informant Questionnaire on Cognitive Decline in the Elderly score was 115 (interquartile range, 79-130) in the 33°C group vs. 115 (interquartile range, 80-130) in the 36°C group (P = .57). The median Informant Questionnaire on Cognitive Decline in the Elderly score was in the decline range for both groups (33°C group median, 79.5; interquartile range, 78-85.9; 36°C group median, 80.7; interquartile range, 78-86.9; P = .04), according to the results.
“Cognitive function was similar in both intervention groups, but many patients and observers reported impairment not detected previously by standard outcome scales,” Tobias Cronberg, MD, PhD, from Skåne University Hospital and Lund University, Lund, Sweden, and colleagues wrote.
There was no difference between the groups in self reports of requiring help with daily activities among survivors (33°C group, 18.8%; 36°C group, 17.5%; P = .71) or in self reports of complete mental recovery (33°C group, 66.5%; 36°C group, 61.8%; P = .32).
The mean mental component and physical component summary scores from the Medical Outcomes Study 36-Item Short Form Health Survey (version 2) to assess quality of life were comparable to the overall population and did not differ between the groups (mental component, 49.1 for 33°C group vs. 49 for 36°C group; P = .79; physical component, 46.8 for 33°C group vs. 47.5 for 36°C group; P = .45).
Long-term outcomes good
“The results of this substudy should shed further light on outcomes after [cardiac arrest] survival and may help design a comprehensive battery of tests that could be used in future studies,” Venkatesh Aiyagari, MBBS, DM, from the departments of neurological surgery and neurology and neurotherapeutics at the University of Texas Southwestern Medical Center, Dallas, and Michael N. Diringer, MD, from the departments of neurology, neurosurgery, anesthesiology and occupational therapy at Washington University School of Medicine, St. Louis, wrote in a related editorial. “An important take-home message from this study is that although cognitive changes are common, the overall long-term outcome of patients with [cardiac arrest] who survive to hospital discharge is quite good.” – by Erik Swain
Disclosures: One researcher reports receiving speaker fees from Phillips and Zoll and four researchers report receiving lecture fees from Bard Medical. Aiyagari and Diringer report no relevant financial disclosures.