Targeted temperature management at 33 versus 36 degrees after out-of-hospital cardiac arrest: A follow-up study

Targeted temperature management (TTM) is commonly used in the setting of out-of-hospital cardiac arrest (OHCA) to improve survival and functional outcomes. However, real-world evidence of effects and optimal temperature are limited. To help address this, we examined associations between TTM and neurologically-intact survival after non-traumatic OHCA across changing institutional TTM temperature goals.

We performed a single-site, retrospective, cohort study of adults with non-traumatic OHCA who arrived comatose to the emergency department and received TTM from 2010 to 2020. Primary exposure was TTM goal temperature. Institutional goal temperature changed from 33 °C (TTM33-1) to 36 °C (TTM36) in 2014 and back to 33 °C (TTM33-2) in 2017. The primary outcome was neurologically-intact survival at discharge, defined as Cerebral Performance Category score of 1 or 2. Secondary outcomes included survival to hospital discharge and care processes. Multivariable logistic regression analysis evaluated association between TTM goal and neurological outcome.

Of 1,469 OCHA patients meeting inclusion criteria, 800 (54%) received TTM. TTM was initiated more frequently during TTM33-1 (60%) than TTM36 (52%) or TTM33-2 (52%). After adjustment for demographic and cardiac arrest characteristics, there was no significant association between TTM goal temperature of 33 °C and neurologically-intact survival, versus 36 °C (adjusted odds ratio 1.10, 95% confidence interval 0.76, 1.60).

TTM goal temperature was not significantly associated with neurologically-intact survival of adult OHCA patients who arrived comatose to the emergency department.