title: Lack of improved outcomes with increased use of targeted temperature management following out-of-hospital cardiac arrest: a multicenter retrospective cohort study.
abstract: OBJECTIVE
  To assess whether increased use of targeted temperature management (TTM) within an integrated healthcare delivery system resulted in improved rates of good neurologic outcome at hospital discharge (Cerebral Performance Category score of 1 or 2).
  
  
  METHODS
  Retrospective cohort study of patients with OHCA admitted to 21 medical centers between January 2007 and December 2012. A standardized TTM protocol and educational program were introduced throughout the system in early 2009. Comatose patients eligible for treatment with TTM were included. Adjusted odds of good neurologic outcome at hospital discharge and survival to hospital discharge were assessed using multivariate logistic regression.
  
  
  RESULTS
  A total of 1119 patients were admitted post-OHCA with coma, 59.1% (661 of 1119) of which were eligible for TTM. The percentage of patients treated with TTM markedly increased during the study period: 10.5% in the years preceding (2007-2008) vs. 85.1% in the years following (2011-2012) implementation of the practice improvement initiative. However, unadjusted in-hospital survival (37.3% vs. 39.0%, p=0.77) and good neurologic outcome at hospital discharge (26.3% vs. 26.6%, p=1.0) did not change. The adjusted odds of survival to hospital discharge (AOR 1.0, 95% CI 0.85-1.17) or a good neurologic outcome (AOR 0.94, 95% CI 0.79-1.11) were likewise non-significant.
  
  
  CONCLUSIONS
  Despite a marked increase in TTM rates across hospitals in an integrated delivery system, there was no appreciable change in the crude or adjusted odds of in-hospital survival or good neurologic outcomes at hospital discharge among eligible post-arrest patients.
authors.affiliation: Department of Emergency Medicine, Kaiser Permanente, 278 West Macarthur Blvd, Oakland, CA, USA. Electronic address: dmark28@gmail.com.
authors.forename: Dustin G
authors.initials: DG
authors.lastname: Mark
authors.affiliation: Department of Emergency Medicine, Kaiser Permanente, Roseville, CA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Yun-Yi
authors.initials: YY
authors.lastname: Hung
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center, Oakland, CA, USA.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Anderson
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.affiliation: Department of Emergency Medicine, Kaiser Permanente, San Rafael, CA, USA.
authors.forename: Dustin W
authors.initials: DW
authors.lastname: Ballard
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001833:Body Temperature Regulation; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Out-of-hospital cardiac arrest; Targeted temperature management; Therapeutic hypothermia