Alignment of targeted temperature management treatment with patients' mortality risk for out-of-hospital cardiac arrest.

ABSTRACT

OBJECTIVE: To examine whether TTM treatment was aligned with predicted mortality risk in patients with resuscitated OHCA during a period when it was a class I guideline-recommended therapy. METHODS: Within the Cardiac Arrest Registry to Enhance Survival for OHCA, we identified adult patients with OHCA who survived to hospital admission and were presumed eligible for TTM. Multivariable models were constructed using pre-hospital variables to predict in-hospital death in patients with shockable and non-shockable rhythms. Within each rhythm category, we divided patients into deciles of predicted mortality risk and examined TTM treatment rates across deciles. RESULTS: From 2013-2019, there were 25,882 successfully resuscitated patients with shockable rhythms and 43,414 patients with non-shockable rhythms presumed eligible for TTM. Of patients with shockable rhythms, predicted in-hospital mortality ranged from 16%-78% in deciles 1-10. TTM treatment increased from 44% in decile 1 to 59% in decile 10 (P for trend < 0.001), but over a third of patients in deciles 4-9 were not treated with TTM. Of patients with non-shockable rhythms, predicted mortality ranged from 48%-95% in deciles 1-10. Although TTM treatment rates increased from 36% in decile 1 to 43% in decile 10 (P for trend 0.003), TTM treatment rates were agnostic to mortality risk (44% to 47%) from decile 2-9. CONCLUSION: TTM treatment patterns were not well-aligned with patients' mortality risk during a period when it was a guideline-recommended treatment for OHCA. Identifying strategies to better align guideline-recommended treatments with patients' mortality risk is critical for efforts to improve OHCA survival.