Targeted Temperature Management Effectiveness in the Elderly: Insights from a Large Registry

Area of Science:

• Cardiology
• Emergency Medicine
• Geriatrics

Background:

• Targeted temperature management (TTM) is standard care for comatose adult out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm.
• Limited data exist on TTM's efficacy and safety in elderly patients (≥75 years).

Purpose of the Study:

• To evaluate the association between TTM and in-hospital mortality and poor neurologic outcomes in elderly OHCA survivors.

Main Methods:

• Analysis of the Cardiac Arrest Registry to Enhance Survival (CARES) dataset (2013-2015).
• Inclusion criteria: age ≥75, survival to hospital admission, known outcomes.
• Outcomes: in-hospital mortality and poor neurologic outcome (CPC Scores 3-4).
• Statistical methods: Hierarchical logistic regression and propensity score matching.

Main Results:

• TTM was administered to 45.5% of eligible elderly OHCA patients.
• No significant association between TTM and in-hospital mortality in patients with ventricular fibrillation (shockable rhythm).
• TTM associated with higher in-hospital mortality in patients with non-shockable rhythms (p<0.001).
• Propensity score analysis showed a modest association between TTM and increased mortality (OR=1.22) but no association with poor neurologic outcome in the elderly.

Conclusions:

• TTM is frequently used in elderly OHCA patients, but its benefits remain uncertain, particularly for those with non-shockable rhythms.
• A randomized controlled trial is necessary to clarify the role of TTM in OHCA survivors aged 75 and older.