title: Impact of time to cooling initiation and time to target temperature in patients treated with hypothermia after cardiac arrest.
abstract: OBJECTIVE
  Little is known about the role of time to initiation of therapeutic hypothermia and time to target temperature (TTT) in the prognosis of patients resuscitated from cardiac arrest.
  
  
  METHODS
  A retrospective analysis was performed in 145 survivors of cardiac arrest who underwent therapeutic hypothermia between January 2003 and January 2013. The objective was to identify predictors of survival free from significant neurological sequelae (Cerebral Performance Categories Scale (CPC): >2) six months after cardiac arrest. We evaluated the effect of faster and earlier cooling.
  
  
  RESULTS
  Overall survival at six months was 42.1% (61 patients); 59 of these were considered to have a good neurological status (CPC ≤ 2), and in whom therapeutic hypothermia was initiated earlier (87 ± 17 min vs. 111 ± 14 min; p=0.042), and the target temperature was reached at an earlier time (TTT: 316 ± 30 min vs. 365 ± 27 min; p=0.017). Multivariate analysis selected longer duration of cardiac arrest (odds ratio (OR) = 1.06 per min), a non-shockable initial rhythm (OR=13.8), severe acidosis (OR=0.009 per 0.01 unit), older age (OR=1.04 per year) and longer TTT (OR=1.005 per min) as associated with poor prognosis.
  
  
  CONCLUSIONS
  The most important prognostic factors for death or lack of neurological recovery in patients with cardiac arrest treated with therapeutic hypothermia are initial-rhythm, time from cardiac arrest to return of spontaneous circulation and arterial-pH at admission. Although the speed of cooling initiation and the time to reach target temperature may play a role, its influence on prognosis seems to be less important.
authors.affiliation: Cardiology Department, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain auribarrig@gmail.com.
authors.forename: Aitor
authors.initials: A
authors.lastname: Uribarri
authors.affiliation: Cardiology Department, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Cardiology Department, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pérez-Castellanos
authors.affiliation: Cardiology Department, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Loughlin
authors.affiliation: Cardiology Department, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain.
authors.forename: Iago
authors.initials: I
authors.lastname: Sousa
authors.affiliation: Cardiology Department, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Viana-Tejedor
authors.affiliation: Cardiology Department, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D000368:Aged; D003080:Cold Temperature; D005260:Female; D006323:Heart Arrest / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiopulmonary resuscitation; heart arrest; induced mild hypothermia; intensive care; neurological outcome