Temperature variability during targeted temperature management is not associated with neurological outcomes following cardiac arrest.
BACKGROUND
Recent studies on comatose survivors of cardiac arrest undergoing targeted temperature management (TTM) have shown similar outcomes at multiple target temperatures. However, details regarding core temperature variability during TTM and its prognostic implications remain largely unknown. We sought to assess the association between core temperature variability and neurological outcomes in patients undergoing TTM following cardiac arrest.


METHODS
We analyzed a prospectively collected cohort of 242 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. Core temperature variability was defined as the statistical variance (i.e. standard deviation squared) amongst all core temperature recordings during the maintenance phase of TTM. Poor neurological outcome at hospital discharge, defined as a Cerebral Performance Category (CPC) score>2, was the primary outcome. Death prior to hospital discharge was assessed as the secondary outcome. Multivariable logistic regression was used to examine the association between temperature variability and neurological outcome or death at hospital discharge.


RESULTS
A poor neurological outcome was observed in 147 (61%) patients and 136 (56%) patients died prior to hospital discharge. In multivariable logistic regression, increased core temperature variability was not associated with increased odds of poor neurological outcomes (OR 0.38, 95% CI 0.11-1.38, p=0.142) or death (OR 0.43, 95% CI 0.12-1.53, p=0.193) at hospital discharge.


CONCLUSIONS
In this study, individual core temperature variability during TTM was not associated with poor neurological outcomes or death at hospital discharge.
University of California, Los Angeles, Department of Medicine, 757 Westwood Plaza, St. 7501, Los Angeles, CA 90095-7417, United States. Electronic address: Anayeri@mednet.ucla.edu.
Arash
A
Nayeri
Vanderbilt University Medical Center, Division of Cardiovascular Medicine, 2220 Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232-6300, United States. Electronic address: N.bhatia@vanderbilt.edu.
Nirmanmoh
N
Bhatia
Vanderbilt University Medical Center, Division of Cardiovascular Medicine, 2220 Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232-6300, United States. Electronic address: Benjamin.b.holmes@Vanderbilt.Edu.
Benjamin
B
Holmes
Vanderbilt University Medical Center, Department of Medicine, 1161 21st Avenue South, D-3100e Medical Center North, Nashville, TN 37232, United States. Electronic address: Nyalborges@gmail.com.
Nyal
N
Borges
Vanderbilt University Medical Center, Department of Medicine, 1161 21st Avenue South, D-3100e Medical Center North, Nashville, TN 37232, United States. Electronic address: William.c.armstrong.1@vanderbilt.edu.
William
W
Armstrong
Vanderbilt University Medical Center, Department of Biostatistics, 2525 West End Ave, St 1100, Nashville, TN 37203, United States. Electronic address: Meng.xu@vanderbilt.edu.
Meng
M
Xu
Vanderbilt University Medical Center, Division of Cardiovascular Medicine, 2220 Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232-6300, United States. Electronic address: Eric.h.farber-eger@Vanderbilt.Edu.
Eric
E
Farber-Eger
Vanderbilt University Medical Center, Division of Cardiovascular Medicine, 2220 Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232-6300, United States. Electronic address: Quinn.s.wells@Vanderbilt.Edu.
Quinn S
QS
Wells
Vanderbilt University Medical Center, Division of Cardiovascular Medicine, 2220 Pierce Avenue, 383 Preston Research Building, Nashville, TN 37232-6300, United States. Electronic address: John.mcpherson@Vanderbilt.Edu.
John A
JA
McPherson
D000368:Aged; D001831:Body Temperature; D003128:Coma / Q000209:etiology; D005260:Female; D005334:Fever / Q000628:therapy*; D006323:Heart Arrest / Q000150:complications / Q000401:mortality*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011446:Prospective Studies; D062606:Tertiary Care Centers; D014481:United States
Cardiac arrest; Cerebral performance category (CPC); Targeted temperature management (TTM); Temperature variability; Therapeutic hypothermia (TH)