Targeted temperature management at 33 versus 36 degrees after out-of-hospital cardiac arrest: A follow-up study

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Aim: Targeted temperature management (TTM) is commonly used in the setting of out-of-hospital cardiac arrest (OHCA) to improve survival and functional outcomes. However, real-world evidence of effects and optimal temperature are limited. To help address this, we examined associations between TTM and neurologically-intact survival after non-traumatic OHCA across changing institutional TTM temperature goals. Methods: We performed a single-site, retrospective, cohort study of adults with non-traumatic OHCA who arrived comatose to the emergency department and received TTM from 2010 to 2020. Primary exposure was TTM goal temperature. Institutional goal temperature changed from 33 °C (TTM33-1) to 36 °C (TTM36) in 2014 and back to 33 °C (TTM33-2) in 2017. The primary outcome was neurologically-intact survival at discharge, defined as Cerebral Performance Category score of 1 or 2. Secondary outcomes included survival to hospital discharge and care processes. Multivariable logistic regression analysis evaluated association between TTM goal and neurological outcome. Results: Of 1,469 OCHA patients meeting inclusion criteria, 800 (54%) received TTM. TTM was initiated more frequently during TTM33-1 (60%) than TTM36 (52%) or TTM33-2 (52%). After adjustment for demographic and cardiac arrest characteristics, there was no significant association between TTM goal temperature of 33 °C and neurologically-intact survival, versus 36 °C (adjusted odds ratio 1.10, 95% confidence interval 0.76, 1.60). Conclusion: TTM goal temperature was not significantly associated with neurologically-intact survival of adult OHCA patients who arrived comatose to the emergency department.

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