title: Hemodynamics and vasopressor support during targeted temperature management at 33°C Versus 36°C after out-of-hospital cardiac arrest: a post hoc study of the target temperature management trial*.
abstract: OBJECTIVE
  To investigate the hemodynamic profile associated with different target temperatures and to assess the prognostic implication of inotropic/vasopressor support and mean arterial pressure after out-of-hospital cardiac arrest. There is a lack of information how different target temperatures may affect hemodynamics.
  
  
  METHODS
  Post hoc analysis of a prospective randomized study.
  
  
  METHODS
  Thirty-six ICUs in 10 countries.
  
  
  METHODS
  Nine hundred twenty patients (97%) with available vasopressor data out of 950 patients from the Target Temperature Management trial randomly assigned patients to a targeted temperature management at 33 °C or 36 °C.
  
  
  METHODS
  None.
  
  
  RESULTS
  Mean arterial pressure, heart rate, and lactate were registered at prespecified time points. The population was stratified according to cardiovascular Sequential Organ Failure Assessment = 4 defining the high vasopressor group and cardiovascular Sequential Organ Failure Assessment less than or equal to 3 defining the low vasopressor group. The targeted temperature management 33 (TTM33) group had a hemodynamic profile with lower heart rate (-7.0 min(-1) [95% confidence limit, -8.7, -5.1]; p(group) < 0.0001), similar mean arterial pressure (-1.1 mm Hg [95% confidence limit, -2.3, 0.2]; p(group) = 0.10), and increased lactate (0.6 mmol/L [95% confidence limit, 0.3, 0.8]; p(group) < 0.0001) compared with the targeted temperature management 36 (TTM36) group. A cardiovascular Sequential Organ Failure Assessment score = 4 was recorded in 54% versus 45%, p = 0.03 in the TTM33 and the TTM36 group, respectively. The high vasopressor group carried a 53% mortality rate when compared with a 34% in the low vasopressor group, p(log-rank) less than 0.0001, with an adjusted hazard ratio of 1.38 (95% CI, 1.11-1.71; p = 0.004). There was no interaction between vasopressor group and allocated target temperature group (p = 0.40). An inverse relationship between mean arterial pressure and mortality was identified (p = 0.0008).
  
  
  CONCLUSIONS
  Targeted temperature management at 33 °C was associated with hemodynamic alterations with decreased heart rate, elevated levels of lactate, and need for increased vasopressor support compared with targeted temperature management at 36 °C. Low mean arterial pressure and need for high doses of vasopressors were associated with increased mortality independent of allocated targeted temperature management.
authors.affiliation: 1Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 2Department of Anesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden. 3Adult Clinical Care, University Hospital of Wales, Cardiff, United Kingdom. 4Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Anesthesia and Intensive Care, IRCCS San Martino IST, Genoa, Italy. 5Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden. 6Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden. 7Department of Cardiothoracic Anaesthesia, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Bro-Jeppesen
authors.forename: Martin
authors.initials: M
authors.lastname: Annborn
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Matt P
authors.initials: MP
authors.lastname: Wise
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Niklas
authors.initials: N
authors.lastname: Nielsen
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
mesh_terms: D000367:Age Factors; D000368:Aged; D001831:Body Temperature; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors; D016037:Single-Blind Method; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid