Effects of targeted temperature management at 33 °C vs. 36 °C on comatose patients after cardiac arrest stratified by the severity of encephalopathy

Sjoukje Nutma; Marleen C Tjepkema-Cloostermans; Barry J Ruijter; Selma C Tromp; Walter M van den Bergh; Norbert A Foudraine; Francois H M Kornips; Gea Drost; Erik Scholten; Aart Strang; Albertus Beishuizen; Michel J A M van Putten; Jeannette Hofmeijer

doi:10.1016/j.resuscitation.2022.01.026

Effects of targeted temperature management at 33 °C vs. 36 °C on comatose patients after cardiac arrest stratified by the severity of encephalopathy

Resuscitation. 2022 Apr:173:147-153. doi: 10.1016/j.resuscitation.2022.01.026. Epub 2022 Feb 2.

Affiliations

¹ Departments of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, the Netherlands; Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands. Electronic address: s.nutma@mst.nl.
² Departments of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, the Netherlands.
³ Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands.
⁴ Departments of Neurology and Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, the Netherlands.
⁵ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁶ Department of Intensive Care, VieCuri Medical Center, Venlo, the Netherlands.
⁷ Department of Neurology, VieCuri Medical Center, Venlo, the Netherlands.
⁸ Departments of Neurology and Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁹ Department of Intensive Care, St Antonius Hospital, Nieuwegein, the Netherlands.
¹⁰ Department of Intensive Care, Rijnstate Hospital, Arnhem, the Netherlands.
¹¹ Department of Intensive Care, Medical Spectrum Twente, Enschede, the Netherlands.
¹² Departments of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, the Netherlands; Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands.
¹³ Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands.

PMID: 35122892
DOI: 10.1016/j.resuscitation.2022.01.026

Abstract

Objectives: To assess neurological outcome after targeted temperature management (TTM) at 33 °C vs. 36 °C, stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24 h.

Design: Post hoc analysis of prospective cohort study.

Setting: Five Dutch Intensive Care units.

Patients: 479 adult comatose post-cardiac arrest patients.

Interventions: TTM at 33 °C (n = 270) or 36 °C (n = 209) and continuous EEG monitoring.

Measurements and main results: Outcome according to the cerebral performance category (CPC) score at 6 months post-cardiac arrest was similar after 33 °C and 36 °C. However, when stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24 h after cardiac arrest, the proportion of good outcome (CPC 1-2) in patients with moderate encephalopathy was significantly larger after TTM at 33 °C (66% vs. 45%; Odds Ratios 2.38, 95% CI = 1.32-4.30; p = 0.004). In contrast, with mild encephalopathy, there was no statistically significant difference in the proportion of patients with good outcome between 33 °C and 36 °C (88% vs. 81%; OR 1.68, 95% CI = 0.65-4.38; p = 0.282). Ordinal regression analysis showed a shift towards higher CPC scores when treated with TTM 33 °C as compared with 36 °C in moderate encephalopathy (cOR 2.39; 95% CI = 1.40-4.08; p = 0.001), but not in mild encephalopathy (cOR 0.81 95% CI = 0.41-1.59; p = 0.537). Adjustment for initial cardiac rhythm and cause of arrest did not change this relationship.

Conclusions: Effects of TTM probably depend on the severity of encephalopathy in comatose patients after cardiac arrest. These results support inclusion of predefined subgroup analyses based on EEG measures of the severity of encephalopathy in future clinical trials.

Keywords: Hypoxic-ischemic encephalopathy; Neuroprotection; Post cardiac arrest syndrome; Postanoxic encephalopathy; Resuscitation; Targeted temperature management.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Body Temperature
Brain Diseases* / etiology
Cardiopulmonary Resuscitation* / methods
Coma / etiology
Coma / therapy
Humans
Hypothermia, Induced* / methods
Out-of-Hospital Cardiac Arrest* / therapy
Prospective Studies