Case Volume of Targeted Temperature Management and Neurological Outcomes in Comatose Out-of-Hospital Cardiac Arrest...

Case volume and improved survival have been reported in several critical illnesses; however, the impact of case volume of targeted temperature management (TTM) on neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients remains unclear. This study aimed to determine whether TTM case volume is associated with neurologically intact survival in comatose OHCA patients.

This observational study included consecutive adult (≥18 years) OHCA survivors with TTM using data from the Nationwide OHCA Registry in South Korea between 2016 and 2021. TTM case volume was evaluated in 2 ways. First, TTM volume was included as a continuous variable in a restricted cubic spline analysis. Second, TTM case volume was categorized into tertiles (high: ≥17.0 cases/year, medium: 12.0-16.9, and low-volume: <12.0 cases/year), and multivariable logistic regression analysis using generalized estimating equations was performed on good neurologic outcomes (cerebral performance category 1-2) based on the low-volume center.

Overall, 4,018 OHCA survivors treated with TTM were included. In spline analyses, the overall association was significant; non-linearity was not detected in the primary 3-knot model but was observed in sensitivity models with alternative knot placements (4-knot: p=0.005; p for non-linearity=0.045). Although coronary angiography was lower in the high-volume center, multivariable analysis showed that a high-volume TTM center was associated with a good neurological outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.16-1.81; p=0.001).

Higher TTM case volume was associated with better neurological outcome in comatose OHCA survivors and may reflect greater overall post-arrest care capability.