Target temperature 34 vs. 36°C after out-of-hospital cardiac arrest - a retrospective observational study.

BACKGROUND: Intensive care for comatose survivors of cardiac arrest includes targeted temperature management (TTM) to attenuate cerebral reperfusion injury. A recent multi-center clinical trial did not show any difference in mortality or neurological outcome between TTM targeting 33°C or 36°C after out-of-hospital-cardiac-arrest (OHCA). In our institution, the TTM target was changed accordingly from 34 to 36°C. The aim of this retrospective study was to analyze if this change had affected patient outcome. METHODS: Intensive care registry and medical record data from 79 adult patients treated for OHCA with TTM during 2010 (n = 38; 34°C) and 2014 (n = 41; 36°C) were analyzed for mortality and neurological outcome were assessed as cerebral performance category. Student's t-test was used for continuous data and Fischer's exact test for categorical data, and multivariable logistic regression was applied to detect influence from patient factors differing between the groups. RESULTS: Witnessed arrest was more common in 2010 (95%) vs. 2014 (76%) (P = 0.03) and coronary angiography was more common in 2014 (95%) vs. 2010 (76%) (P = 0.02). The number of patients awakening later than 72 h after the arrest did not differ. After adjusting for gender, hypertension, and witnessed arrest, neither 1-year mortality (P = 0.77), nor 1-year good neurological outcome (P = 0.85) differed between the groups. CONCLUSION: Our results, showing no difference between TTM at 34°C and TTM at 36°C as to mortality or neurological outcome after OHCA, are in line with the previous TTM-trial results, supporting the use of either target temperature in our institution.

Factors influencing the decision to ICD implantation in survivors of OHCA and its influence on long term survival.

BACKGROUND: Knowledge is insufficient of the long-term benefit of an implantable cardioverter defibrillator (ICD) after out of hospital cardiac arrest (OHCA). AIM: To describe the use and factors of importance for outcome in relation to ICD use among survivors of ventricular fibrillation (VF). METHODS: In consecutive patients discharged alive after OHCA in Gothenburg between 1988 and 2008 the long-term prognosis was followed. RESULTS: In all, there were 5443 OHCAs of which 1489 (27%) were hospitalized alive. Of those, 495 (33%) were discharged alive, of which 390 (79%) had shockable rhythm. The use of ICDs increased, but only 58 of 390 (15%) had an ICD. Among patients who received an ICD, the 2-year mortality was 2%, versus 25% of those who did not (p<0.0001). In follow-up (mean 5.5 years; maximum 10 years), the use of an ICD showed a borderline association with mortality (adjusted hazard ratio 0.49; 95% confidence interval, 024-1.01; p=0.052). Patients who had ICD were younger and had better cerebral function compared with patients without. Predictors for mortality were cerebral function at discharge, age, history of heart failure and myocardial infarction and no coronary angiography during hospitalization. CONCLUSION: Among survivors of OHCA caused by VT/VF who had ICD during hospitalization only 2% died during the subsequent 2 years. The use of ICDs was low but increasing. Factors of importance for mortality were cerebral function at the time of discharge, age, history of heart failure and myocardial infarction and no coronary angiography during hospitalization.