Effectiveness of each target body temperature during therapeutic hypothermia after cardiac arrest.
OBJECTIVE
According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation, unconscious adult patients with a return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours. However, it is unclear which target temperature is more adequate. In this study, we prospectively evaluated the outcome and adverse effects following 3 target temperatures (32°C, 33°C, and 34°C) during therapeutic hypothermia with ROSC after out-of-hospital cardiac arrest.


METHODS
This is a prospective study of patients with ROSC (>24 hours) after out-of-hospital cardiac arrest who were admitted to the intensive care unit in a tertiary hospital and underwent therapeutic hypothermia during a 22-month period between March 2007 and December 2008.


RESULTS
Sixty-two patients were included. The number of male patients was 44. The mean (SD) ages of the patients was 54.61 (2.002) years. There were 13, 22, and 28 patients who were enrolled in the target temperatures (32°C, 33°C, and 34°C, respectively). There were no significant differences after each target temperature with respect to mortality and neurologic outcomes. Regarding adverse effects, hypotension during the maintenance of therapeutic hypothermia significantly increased when the target temperature was 32°C (P = .023). Based on multivariate analysis, hypotension during the maintenance of therapeutic hypothermia was increased more than 6 times at 32°C compared with 33°C (odds ratio, 6.800; 95% confidence interval, 1.428-32.373).


CONCLUSIONS
When performing therapeutic hypothermia in patients with ROSC after an out-of-hospital cardiac arrest, the target temperature would be set to 33°C or 34°C, rather than 32°C. Further multicenter randomized controlled studies may be needed in the future.
Kim
Jin Joo
JJ
Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea. empearl@gilhospital.com
Yang
Hyuk Jun
HJ
Lim
Yong Su
YS
Kim
Jae Kwang
JK
Hyun
Sung Youl
SY
Hwang
Sung Youn
SY
Shin
Jong Hwan
JH
Park
Jung Bea
JB
Lee
Gun
G
D001831:Body Temperature / Q000502:physiology*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome