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Prolonged, short targeted temperature management yield similar outcomes after cardiac arrest

Favorable neurologic outcomes at 6 months did not significantly differ in adults with out-of-hospital cardiac arrest treated with targeted temperature management for 48 hours vs. 24 hours, according to a study published in JAMA.

“Short- and long-term outcomes in unconscious patients admitted to the ICU after out-of-hospital cardiac arrest are characterized by prognostic uncertainty and a high risk of death and neurologic deficit,” Hans Kirkegaard, MD, PhD, from Aarhus University Hospital, Denmark, and colleagues wrote. “To improve the chance of survival and neurologic recovery, international guidelines recommend use of targeted temperature management, together with urgent coronary angiography and percutaneous coronary intervention when appropriate, and delayed multimodal prognostication before withdrawal of care.”

These guidelines suggest that total temperature management between 33°C and 36°C offer similar benefits, “but the optimal duration of cooling is still under debate,” they added.

Kirkegaard and colleagues conducted a randomized clinical trial in 10 ICUs at 10 university hospitals in six European countries to determine if total temperature management at 33°C provides better neurologic outcomes at 48 hours than the currently recommended 24 hours. They enrolled 355 unconscious patients with out-of-hospital cardiac arrest (mean age, 60 years; 83% men) between Feb. 16, 2013, and June 1, 2016 and followed them until Dec. 27, 2016. Participants were randomly assigned to receive total temperature management at 33±1°C for 48 hours (n = 176) or 24 hours (n = 179). Afterward, gradual rewarming of 0.5°C per hour until reaching 37°C was performed. The researchers defined a favorable neurologic outcome as having a Cerebral Performance Categories score of 1 or 2 at month 6.

Of the 351 patients who completed the trial, more favorable outcomes were observed in the 48-hour group than the 24-hour group (69% vs. 64%); however, this difference was not statistically significant. There was no difference between the groups in 6-month mortality. Compared with the 24-hour group, the 48-hour group experienced more adverse events. Time to mortality did not differ significantly (HR = 0.79; 95% CI, 0.54-1.15). The median length of ICU stay was longer in the 48-hour group (151 vs. 117 hours; P < .001), but not the hospital stay (12 vs. 11 days).

“In unconscious survivors from out-of-hospital cardiac arrest admitted to the ICU, targeted temperature management at 33°C for 48 hours did not significantly improve 6-month neurologic outcome compared with targeted temperature management at 33°C for 24 hours,” Kirkegaard and colleagues concluded. “However, the study may have had limited power to detect clinically important differences, and further research may be warranted.” – by Alaina Tedesco

Disclosure: Kirkegaard reports no relevant financial disclosures. Please see full study for complete list of all other authors’ disclosures.