title: Assessment of risk factors for post-rewarming "rebound hyperthermia" in cardiac arrest patients undergoing therapeutic hypothermia.
abstract: BACKGROUND
  The outcomes associated with therapeutic hypothermia (TH) after cardiac arrest, while overwhelmingly positive, may be associated with adverse events. The incidence of post-rewarming rebound hyperthermia (RH) has been relatively unstudied and may worsen survival and neurologic outcome. The purpose of this study was to determine the incidence and risk factors associated with RH as well as its relationship to mortality, neurologic morbidity, and hospital length of stay (LOS).
  
  
  METHODS
  A retrospective, observational study was performed of adult patients who underwent therapeutic hypothermia after an out-of-hospital cardiac arrest. Data describing 17 potential risk factors for RH were collected. The primary outcome was the incidence of RH while the secondary outcomes were mortality, discharge neurologic status, and LOS.
  
  
  RESULTS
  141 patients were included. All 17 risk factors for RH were analyzed and no potential risk factors were found to be significant at a univariate level. 40.4% of patients without RH experienced any cause of death during the initial hospitalization compared to 64.3% patients who experienced RH (OR: 2.66; 95% CI: 1.26-5.61; p=0.011). The presence of RH is not associated with an increase in LOS (10.67 days vs. 9.45 days; absolute risk increase=-1.21 days, 95% CI: -1.84 to 4.27; p=0.434). RH is associated with increased neurologic morbidity (p=0.011).
  
  
  CONCLUSIONS
  While no potential risk factors for RH were identified, RH is a marker for increased mortality and worsened neurologic morbidity in cardiac arrest patients who have underwent TH.
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, MI, USA. spwi@med.umich.edu
authors.forename: S A
authors.initials: SA
authors.lastname: Winters
authors.forename: K H
authors.initials: KH
authors.lastname: Wolf
authors.forename: S A
authors.initials: SA
authors.lastname: Kettinger
authors.forename: E K
authors.initials: EK
authors.lastname: Seif
authors.forename: J S
authors.initials: JS
authors.lastname: Jones
authors.forename: T
authors.initials: T
authors.lastname: Bacon-Baguley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005334:Fever / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D017694:Rewarming / Q000009:adverse effects*; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac arrest; Length of stay; Mortality; Neurologic morbidity; Rebound hyperthermia; Therapeutic hypothermia