title: The association of targeted temperature management at 33 and 36 °C with outcome in patients with moderate shock on admission after out-of-hospital cardiac arrest: a post hoc analysis of the Target Temperature Management trial.
abstract: OBJECTIVE
  We hypothesized that a targeted temperature of 33 °C as compared to that of 36 °C would increase survival and reduce the severity of circulatory shock in patients with shock on admission after out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  The recently published Target Temperature Management trial (TTM-trial) randomized 939 OHCA patients with no difference in outcome between groups and no difference in mortality at the end of the trial in a predefined subgroup of patients with shock at admission. Shock was defined as a systolic blood pressure of <90 mm Hg for >30 min or the need of supportive measures to maintain a blood pressure ≥90 mmHg and/or clinical signs of end-organ hypoperfusion. In this post hoc analysis reported here, we further analyzed the 139 patients with shock at admission; all had been randomized to receive intervention at 33 °C (TTM33; n = 71) or 36 °C (TTM36; n = 68). Primary outcome was 180-day mortality. Secondary outcomes were intensive care unit (ICU) and 30-day mortality, severity of circulatory shock assessed by mean arterial pressure, serum lactate, fluid balance and the extended Sequential Organ Failure assessment (SOFA) score.
  
  
  RESULTS
  There was no significance difference between targeted temperature management at 33 °C or 36 °C on 180-day mortality [log-rank test, p = 0.17, hazard ratio 1.33, 95 % confidence interval (CI) 0.88-1.98] or ICU mortality (61 vs. 44 %, p = 0.06; relative risk 1.37, 95 % CI 0.99-1.91). Serum lactate and the extended cardiovascular SOFA score were higher in the TTM33 group (p < 0.01).
  
  
  CONCLUSIONS
  We found no benefit in survival or severity of circulatory shock with targeted temperature management at 33 °C as compared to 36 °C in patients with shock on admission after OHCA.
authors.affiliation: Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85, Lund, Sweden, martinannborn@hotmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Annborn
authors.forename: John
authors.initials: J
authors.lastname: Bro-Jeppesen
authors.forename: Niklas
authors.initials: N
authors.lastname: Nielsen
authors.forename: Susann
authors.initials: S
authors.lastname: Ullén
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.forename: Jan
authors.initials: J
authors.lastname: Hovdenes
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pellis
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Matt P
authors.initials: MP
authors.lastname: Wise
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
mesh_terms: D000368:Aged; D001831:Body Temperature; D005260:Female; D006760:Hospitalization; D006801:Humans; D007036:Hypothermia, Induced / Q000592:standards*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000628:therapy*; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology / Q000628:therapy*