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Tytuł pozycji:

Targeted Temperature Management at 33 Versus 36 Degrees: A Retrospective Cohort Study.

Tytuł:
Targeted Temperature Management at 33 Versus 36 Degrees: A Retrospective Cohort Study.
Autorzy:
Johnson NJ; Department of Emergency Medicine, University of Washington, Seattle, WA.; Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Danielson KR; Airlift Northwest, UW Medicine, Seattle, WA.
Counts CR; Department of Emergency Medicine, University of Washington, Seattle, WA.
Ruark K; Seattle Fire Department, Seattle, WA.; University of North Dakota School of Medicine, Grand Forks, ND.
Scruggs S; Department of Emergency Medicine, University of Washington, Seattle, WA.
Hough CL; Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Maynard C; Department of Health Services, University of Washington, Seattle, WA.
Sayre MR; Department of Emergency Medicine, University of Washington, Seattle, WA.; Seattle Fire Department, Seattle, WA.
Carlbom DJ; Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Źródło:
Critical care medicine [Crit Care Med] 2020 Mar; Vol. 48 (3), pp. 362-369.
Typ publikacji:
Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: New York, Kolen.
MeSH Terms:
Coma/*etiology
Coma/*therapy
Hypothermia, Induced/*methods
Out-of-Hospital Cardiac Arrest/*complications
Trauma Centers/*statistics & numerical data
Adult ; Age Factors ; Aged ; Body Temperature ; Coma/mortality ; Female ; Hospital Mortality/trends ; Humans ; Hypothermia, Induced/mortality ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest/mortality ; Out-of-Hospital Cardiac Arrest/therapy ; Outcome and Process Assessment, Health Care ; Patient Discharge ; Retrospective Studies ; Socioeconomic Factors
Grant Information:
U01 HL123008 United States HL NHLBI NIH HHS
Entry Date(s):
Date Created: 20191207 Date Completed: 20201023 Latest Revision: 20201023
Update Code:
20240104
DOI:
10.1097/CCM.0000000000004159
PMID:
31809279
Czasopismo naukowe
Objectives: To determine the association between targeted temperature management goal temperature of 33°C versus 36°C and neurologic outcome after out-of-hospital cardiac arrest.
Design: This was a retrospective, before-and-after, cohort study.
Setting: Urban, academic, level 1 trauma center from 2010 to 2017.
Patients: Adults with nontraumatic out-of-hospital cardiac arrest who received targeted temperature management.
Interventions: Our primary exposure was targeted temperature management goal temperature, which was changed from 33°C to 36°C in April of 2014 at the study hospital. Primary outcome was neurologically intact survival to discharge. Secondary outcomes included hospital mortality and care processes.
Measurements and Main Results: Of 782 out-of-hospital cardiac arrest patients transported to the study hospital, 453 (58%) received targeted temperature management. Of these, 258 (57%) were treated during the 33°C period (targeted temperature management 33°C) and 195 (43%) were treated during the 36°C period (targeted temperature management 36°C). Patients treated during targeted temperature management 33°C were older (57 vs 52 yr; p < 0.05) and had more arrests of cardiac etiology (45% vs 35%; p < 0.05), but otherwise had similar baseline characteristics, including initial cardiac rhythm. A total of 40% of patients treated during targeted temperature management 33°C survived with favorable neurologic outcome, compared with 30% in the targeted temperature management 36°C group (p < 0.05). After adjustment for demographic and cardiac arrest characteristics, targeted temperature management 33°C was associated with increased odds of neurologically intact survival to discharge (odds ratio, 1.79; 95% CI, 1.09-2.94). Targeted temperature management 33°C was not associated with significantly improved hospital mortality. Targeted temperature management was implemented faster (1.9 vs 3.5 hr from 911 call; p < 0.001) and more frequently in the emergency department during the targeted temperature management 33°C period (87% vs 55%; p < 0.001).
Conclusions: Comatose, adult out-of-hospital cardiac arrest patients treated during the targeted temperature management 33°C period had higher odds of neurologically intact survival to hospital discharge compared with those treated during the targeted temperature management 36°C period. There was no significant difference in hospital mortality.

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