title: Target temperature management of 33°C and 36°C in patients with out-of-hospital cardiac arrest with initial non-shockable rhythm - a TTM sub-study.
abstract: OBJECTIVE
  Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm (NSR), guidelines recommend induced hypothermia to be considered in these patients. We assessed the effect on outcome of two levels of induced hypothermia in comatose patient resuscitated from NSR.
  
  
  METHODS
  Hundred and seventy-eight patients out of 950 in the TTM trial with an initial NSR were randomly assigned to targeted temperature management at either 33°C (TTM33, n=96) or 36°C (TTM36, n=82). We assessed mortality, neurologic function (Cerebral Performance Score (CPC) and modified Rankin Scale (mRS)), and organ dysfunction (Sequential Organ Failure Assessment (SOFA) score).
  
  
  RESULTS
  Patients with NSR were older, had longer time to ROSC, less frequently had bystander CPR and had higher lactate levels at admission compared to patients with shockable rhythm, p<0.001 for all. Mortality in patients with NSR was 84% in both temperature groups (unadjusted HR 0.92, adjusted HR 0.75; 95% CI 0.53-1.08, p=0.12). In the TTM33 group 3% survived with poor neurological outcome (CPC 3-4, mRS 4-5), compared to 2% in the TTM36 group (adjusted OR 0.67; 95% CI 0.08-4.73, p=0.69 for both). Thirteen percent in the TTM33 group and 15% in the TTM36 group had good neurologic outcome (CPC 1-2, mRS 0-3, OR 1.5, CI 0.21-12.5, p=0.69). The SOFA-score did not differ between temperature groups.
  
  
  CONCLUSIONS
  Comatose patients after OHCA with initial NSR continue to have a poor prognosis. We found no effect of targeted temperature management at 33°C compared to 36°C in these patients.
authors: The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: martin.frydland@me.com.
authors: Martin
authors: M
authors: Frydland
authors: The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Jesper
authors: J
authors: Kjaergaard
authors: Department of Cardiology, Skåne University Hospital, Lund, Sweden.
authors: David
authors: D
authors: Erlinge
authors: The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Michael
authors: M
authors: Wanscher
authors: Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
authors: Niklas
authors: N
authors: Nielsen
authors: Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy.
authors: Tommaso
authors: T
authors: Pellis
authors: Department of Intensive Care, Liverpool hospital, Sydney, New South Wales, Australia.
authors: Anders
authors: A
authors: Åneman
authors: Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
authors: Hans
authors: H
authors: Friberg
authors: Department of Anaesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Jan
authors: J
authors: Hovdenes
authors: Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands.
authors: Janneke
authors: J
authors: Horn
authors: Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark.
authors: Jørn
authors: J
authors: Wetterslev
authors: The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Matilde
authors: M
authors: Winther-Jensen
authors: Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom.
authors: Matthew P
authors: MP
authors: Wise
authors: Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands.
authors: Michael
authors: M
authors: Kuiper
authors: Department of Anaesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg.
authors: Pascal
authors: P
authors: Stammet
authors: Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden.
authors: Tobias
authors: T
authors: Cronberg
authors: Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland.
authors: Yvan
authors: Y
authors: Gasche
authors: The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Christian
authors: C
authors: Hassager
mesh_terms: D000368:Aged; D001831:Body Temperature; D016887:Cardiopulmonary Resuscitation; D004554:Electric Countershock; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000517:prevention & control; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Mortality; Neurologic function; Non-shockable rhythm; Out-of-hospital cardiac arrest; SOFA score; Targeted temperature management