Targeted Temperature Management Experience of an Academic Emergency Department: A 5-Year Retrospective Study

Area of Science:

• Emergency Medicine
• Critical Care
• Cardiology

Background:

• Targeted temperature management (TTM) is crucial for postcardiac arrest syndrome, reducing mortality and neurological harm.
• Intensive care units (ICUs) may have limited availability, necessitating alternative settings for critical care.
• The emergency department (ED) can serve as a site for initiating TTM when ICUs are full.

Purpose of the Study:

• To investigate the characteristics and mortality of postcardiac arrest patients receiving TTM in an academic ED.
• To evaluate the feasibility and outcomes of early TTM initiation in an emergency department setting.
• To identify predictors of neurological outcomes in postcardiac arrest patients treated with TTM.

Main Methods:

• Retrospective analysis of postcardiac arrest patients who underwent TTM in a tertiary care academic ED in Turkey.
• Data collected from January 1, 2014, to November 1, 2018.
• Patient demographics, cardiopulmonary resuscitation duration, neurological status (light reflexes), and outcomes (discharge, mortality, organ donation) were analyzed.

Main Results:

• TTM was initiated in the ED for 24 patients (mean age 60.7 ± 19.2 years).
• Five patients (20.8%) were discharged, with 80% of these being out-of-hospital cardiac arrest (OHCA) survivors.
• Mortality was 100% for patients with >25 minutes of cardiopulmonary resuscitation, and lack of light reflexes was associated with significantly higher mortality (p=0.006).

Conclusions:

• Early TTM initiation in the ED can be a viable option when ICUs are unavailable, potentially improving neurological outcomes.
• Out-of-hospital cardiac arrest and the presence of light reflexes appear to be positive prognostic indicators.
• Emergency physicians should consider and be encouraged to implement TTM in the ED for postcardiac arrest patients.