title: Effect of prolonged targeted temperature management on left ventricular myocardial function after out-of-hospital cardiac arrest - A randomised, controlled trial.
abstract: To evaluate post-cardiac arrest myocardial dysfunction during prolonged targeted temperature management (TTM) compared with standard TTM in comatose out-of-hospital cardiac arrest (OHCA) survivors.
  
  
  
  A randomised, controlled trial comparing myocardial function after TTM at 33 ±1°C for 48h compared with 24h. A total of 105 OHCA patients were computer-randomised to 24h (n=50) or 48h (n=55) of TTM. Transthoracic echocardiography was performed after 24h, 48h and 72h. Echocardiographic parameters were evaluated by an investigator who was blinded to randomisation. The primary endpoint was peak systolic mitral annular velocity (Ś) measured as the difference in the period from 24h to 72h. The model was adjusted for age, primary rhythm and heart rate. The secondary outcomes were global peak longitudinal strain, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and the diastolic measures e' and E/e'.
  
  
  
  The mean difference of S' was significantly increased in the 48h group compared with the 24h group: -1.14cm/s (-1.83; -0.45), p=0.001. This difference was consistent after adjusting the data (p=0.008). However, there were no significant changes between the study groups with respect to the adjusted secondary outcomes of global peak longitudinal strain (p=0.07), LVEF (p=0.31), TAPSE (p=0.91), e' (p=0.26) and E/e' (p=0.18).
  
  
  
  Prolonged TTM at 33°C of 48h compared with 24h in comatose OHCA survivors may improve the recovery of post-cardiac arrest left myocardial dysfunction demonstrated by the echocardiographic outcome, S'. ClinicalTrials.gov identifier: NCT02066753.
authors.affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark; Department of Anaesthesiology, Regional Hospital Horsens, Sundvej 30, DK-8700 Horsens, Denmark. Electronic address: anders.grejs@dadlnet.dk.
authors.forename: Anders Morten
authors.initials: AM
authors.lastname: Grejs
authors.affiliation: Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
authors.forename: Bent Roni Ranghøj
authors.initials: BRR
authors.lastname: Nielsen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Juhl-Olsen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Gjedsted
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Sloth
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
authors.forename: Johan
authors.initials: J
authors.lastname: Heiberg
authors.affiliation: Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
authors.forename: Christian Alcaraz
authors.initials: CA
authors.lastname: Frederiksen
authors.affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
authors.forename: Anni Nørgaard
authors.initials: AN
authors.lastname: Jeppesen
authors.affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
authors.forename: Christophe Henri Valdemar
authors.initials: CHV
authors.lastname: Duez
authors.affiliation: Department of Cardiology, Stavanger University Hospital, Armauer Hansens Vei 20, NO-4011 Stavanger, Norway.
authors.forename: Per Dreyer
authors.initials: PD
authors.lastname: Hamre
authors.affiliation: Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Armauer Hansens vei 20, NO-4011 Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies Veg 91B, N.5021 Bergen, Norway.
authors.forename: Eldar
authors.initials: E
authors.lastname: Søreide
authors.affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D003128:Coma / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Body temperature regulation; Cardiac arrest; Echocardiography; Heart arrest; Out-of-hospital cardiac arrest; Post resuscitation care; Targeted temperature management; Temperature; Therapeutic hypothermia