Targeted temperature management is related to improved clinical outcome of out-of-hospital cardiac arrest with non-shockable initial rhythm

Kim, Seok Goo; Cha, Won Chul; Sim, Min Seob; Hwang, Sung Yeon; Shin, Tae Gun; Park, Joo Hyun; Yoon, Hee; Jo, Ik Joon; Choi, Jin-Ho

J Korean Soc Emerg Med > Volume 30(3); 2019 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2019;30(3): 208-216.

Targeted temperature management is related to improved clinical outcome of out-of-hospital cardiac arrest with non-shockable initial rhythm

Seok Goo Kim

, Won Chul Cha

, Min Seob Sim, Sung Yeon Hwang

, Tae Gun Shin

, Joo Hyun Park, Hee Yoon

, Ik Joon Jo, Jin-Ho Choi

Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence

Jin-Ho Choi ,Tel: 02-3410-2053, Fax: 02-3410-3849, Email: jhchoimd@gmail.com,

Received: August 24, 2018; Revised: October 1, 2018 Accepted: October 3, 2018. Published online: June 30, 2019.

ABSTRACT

Objective:
The benefits of targeted temperature management (TTM) for resuscitated out of hospital cardiac arrest (OHCA) with an initial non-shockable rhythm are still unclear. This study examined whether TTM reduces the mortality and improves the neurological outcomes of OHCA with a non-shockable initial rhythm.
Method:
This study analyzed the clinical outcome of 401 resuscitated patients with an initial non-shockable rhythm among a total of 1,616 OHCA patients who were registered in Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance. The impact of TTM was investigated after accounting for the patients’ propensity for TTM. The primary outcome was a 30-day in-hospital course with a neurologically favorable outcome defined by a cerebral performance categories scale ≤2.
Results:
TTM was performed in 89 patients (22%) with an initial non-shockable rhythm. Patients who has received TTM had a tendency to be younger, more likely to be female, and more likely to undergo percutaneous coronary intervention. The clinical outcome of the patients in the initial non-shockable rhythm treated by TTM was superior to those without TTM (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.27-0.46). Further analysis after propensity score matching or inverse probability of treatment weighting (IPTW) showed consistent findings (propensity score matching: HR, 0.32; 95% CI, 0.22-0.45; IPTW: HR, 0.40; 95% CI, 0.31-0.52; P<0.001, all).
Conclusion:
In this nationwide OHCA registry, TTM was related to an approximately three-fold better 30-day neurologically favorable survival of resuscitated patients with TTM treatment than patients without TTM in the initial non-shockable rhythm.

Key words: Out-of-hospital cardiac arrest; Induced hypothermia; Cardiopulmonary resuscitation; Prognosis