The effect of different target temperatures in targeted temperature management on neurologically favorable outcome after out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM-OHCA registry)

Taro Irisawa; Tasuku Matsuyama; Taku Iwami; Tomoki Yamada; Koichi Hayakawa; Kazuhisa Yoshiya; Kazuo Noguchi; Tetsuro Nishimura; Toshifumi Uejima; Yoshiki Yagi; Takeyuki Kiguchi; Masafumi Kishimoto; Makoto Matsuura; Yasuyuki Hayashi; Taku Sogabe; Takaya Morooka; Tetsuhisa Kitamura; Takeshi Shimazu; CRITICAL Study investigators

doi:10.1016/j.resuscitation.2018.10.004

The effect of different target temperatures in targeted temperature management on neurologically favorable outcome after out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM-OHCA registry)

Resuscitation. 2018 Dec:133:82-87. doi: 10.1016/j.resuscitation.2018.10.004. Epub 2018 Oct 11.

Authors

Taro Irisawa¹, Tasuku Matsuyama², Taku Iwami³, Tomoki Yamada⁴, Koichi Hayakawa⁵, Kazuhisa Yoshiya³, Kazuo Noguchi⁶, Tetsuro Nishimura⁷, Toshifumi Uejima⁸, Yoshiki Yagi⁹, Takeyuki Kiguchi¹⁰, Masafumi Kishimoto¹¹, Makoto Matsuura¹², Yasuyuki Hayashi¹³, Taku Sogabe¹⁴, Takaya Morooka¹⁵, Tetsuhisa Kitamura¹⁶, Takeshi Shimazu¹⁷; CRITICAL Study investigators

Affiliations

¹ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: [email protected].
² Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
³ Kyoto University Health Services, Kyoto, Japan.
⁴ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan.
⁵ Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan.
⁶ Department of Emergency Medicine, Tane General Hospital, Osaka, Japan.
⁷ Department of Critical Care Medicine, Osaka City University, Osaka, Japan.
⁸ Department of Emergency and Critical Care Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan.
⁹ Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.
¹⁰ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan.
¹¹ Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi, Osaka, Japan.
¹² Senshu Trauma and Critical Care Center, Osaka, Japan.
¹³ Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan.
¹⁴ Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁵ Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
¹⁶ Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹⁷ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

PMID: 30316953
DOI: 10.1016/j.resuscitation.2018.10.004

Abstract

Background: It has been insufficiently investigated whether neurological function after out-of-hospital cardiac arrest (OHCA) would differ by 1 °C change in ordered target temperature of 33-36 °C among patients undergoing targeted temperature management (TTM) in the real-world setting.

Methods: This nationwide hospital-based observational study (The Japanese Association for Acute Medicine-OHCA Registry) conducted between June 2014 and December 2015 in Japan included OHCA patients aged ≥18 years who were treated with TTM. The primary outcome was one-month survival with neurologically favorable outcomes defined by cerebral performance category 1 or 2. To investigate the effect of TTM by 1 °C change in ordered target temperature of 33-36 °C on each outcome, random effects logistic regression analyses were performed.

Results: The final analysis included 738 patients. The proportion of patients with neurologically favorable outcome was 30.4% (7/23), 31.7% (175/552), 28.9% (11/38), and 30.4% (38/125) in the 33 °C, 34 °C, 35 °C, and 36 °C groups, respectively. In the multivariable logistic regression analysis, no group had a higher proportion of neurologically favorable outcome compared with the 34 °C group (vs. 33 °C group, adjusted odds ratio [AOR] 0.90; 95% confidence interval [CI] 0.25-3.12, vs. 35 °C group, AOR 1.17; 95% CI 0.44-3.13, vs. 36 °C group, AOR 1.26; 95% CI 0.78-2.02).

Conclusions: In this population, we evaluated the difference in outcomes after adult OHCA patients received TTM by 1 °C change in ordered target temperature of 33-36 °C and demonstrated that there was no statistically significant difference in neurologically favorable outcomes after OHCA irrespective of target temperature.

Keywords: Neurologically favorable outcome; Out-of-hospital cardiac arrest; Post-cardiac arrest syndrome; Targeted temperature management.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Cardiopulmonary Resuscitation / methods
Female
Humans
Hypothermia, Induced / methods*
Japan
Logistic Models
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / epidemiology
Out-of-Hospital Cardiac Arrest / therapy*
Outcome Assessment, Health Care / statistics & numerical data*
Registries
Retrospective Studies
Temperature*