title: Magnitude of temperature elevation is associated with neurologic and survival outcomes in resuscitated cardiac arrest patients with postrewarming pyrexia.
abstract: Avoidance of pyrexia is recommended in resuscitation guidelines, including after treatment with targeted temperature management (TTM). Which aspects of postresuscitation pyrexia are harmful and modifiable have not been conclusively determined.
  
  
  
  This retrospective multicenter registry study collected serial temperatures during 72 hours postrewarming to assess the relationship between 3 aspects of pyrexia (maximum temperature, pyrexia duration, timing of first pyrexia) and neurologic outcome (primary) and survival (secondary) at hospital discharge. Adult TTM-treated patients from 13 US hospitals between 2005 and 2015 were included.
  
  
  
  One hundred seventy-nine of 465 patients had at least 1 temperature greater than or equal to 38°C. Pyrexic temperatures were associated with better survival than nonpyrexic temperatures (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.00-2.35). Higher maximum temperature was associated with worse outcome (neurologic aOR, 0.30 [95% CI, 0.10-0.84]; survival aOR, 0.25 [95% CI, 0.10-0.59]) in pyrexic patients. There was no significant relationship between pyrexia duration and outcomes unless duration was calculated as hours greater than or equal to 38.8°C, when longer duration was associated with worse outcomes (neurologic aOR, 0.86 [95% CI, 0.75-1.00]; survival aOR, 0.82 [95% CI, 0.72-0.93]).
  
  
  
  In postarrest TTM-treated patients, pyrexia was associated with increased survival. Patients experiencing postrewarming pyrexia had worse outcomes at higher temperatures. Longer pyrexia duration was associated with worse outcomes at higher temperatures.
authors.affiliation: Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104; Leonard Davis Institute of Healthcare Economics, University of Pennsylvania, Philadelphia, PA 19104. Electronic address: agrosses@bidmc.harvard.edu.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Grossestreuer
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA 19107. Electronic address: david.gaieski@jefferson.edu.
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215. Electronic address: mdonnino@bidmc.harvard.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104; Leonard Davis Institute of Healthcare Economics, University of Pennsylvania, Philadelphia, PA 19104. Electronic address: dwiebe@exchange.upenn.edu.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
authors.affiliation: Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104. Electronic address: benjamin.abella@uphs.upenn.edu.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
mesh_terms: D001831:Body Temperature; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D009422:Nervous System Diseases / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D010351:Patient Discharge; D010414:Pennsylvania; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Body temperature; Fever; Heart arrest; Hypothermia, induced; Myocardial ischemic reperfusion injury; Retrospective study