The influence of body composition on therapeutic hypothermia: a prospective observational study of patients after cardiac arrest.
BACKGROUND
Patients after out-of-hospital cardiac arrest (OHCA) benefit from therapeutic hypothermia for 24 hours. The time needed to reach hypothermia (target temperature of 32 degrees C to 34 degrees C) varies widely. In this study, we explore the relation between measures of body composition and the time needed to reach target temperature with hypothermia.


METHODS
We conducted a prospective observational study in patients treated with hypothermia after OHCA. Data collected included weight and height, body composition by anthropometric measures and by single-frequency body impedance, and waist-to-hip ratio. Analysis of concordance between impedance and anthropometric measures and hazard ratios of achieving target temperature (event) corrected for different body composition measures.


RESULTS
Twenty-seven patients were included. The median (interquartile range) time to reach target temperature after admission to the intensive care unit was 191 (105 to 382) minutes. Intraclass correlation for total body fat (TBF) measures was 0.94 (95% confidence interval [CI] 0.89 to 0.97). Only TBF percentage (anthropometrics by the Durnin's table) appeared to be associated with time to reach target temperature: 0.93 (95% CI 0.87 to 0.99; P = 0.03).


CONCLUSIONS
The body composition measures from single-frequency impedance and anthropometrics appear to be very concordant. Only TBF percentage (anthropometrics) showed a significant but clinically irrelevant influence on time needed to achieve target temperature with hypothermia. We conclude that there are no indications to adjust current cooling practice toward the body composition of patients.
Jimmink
Joost J
JJ
Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, 1100DD Amsterdam, The Netherlands. J.J.Jimmink@amc.uva.nl
Binnekade
Jan M
JM
Paulus
Frederique
F
Mathus-Vliegen
Elisebeth M H
EM
Schultz
Marcus J
MJ
Vroom
Margreeth B
MB
D000368:Aged; D001823:Body Composition / Q000502:physiology*; D001831:Body Temperature / Q000502:physiology; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies