Real-World Practice of Target Temperature Management in Acute Brain Injury: Associations with Coagulopathy and...

Area of Science:

• Neurology
• Critical Care Medicine
• Neurocritical Care

Background:

• Target temperature management (TTM) is a standard neuroprotective therapy for acute brain injury.
• Real-world TTM implementation varies, with unclear implications of different temperature targets and durations.
• Understanding TTM's impact on coagulopathy and mortality is crucial for optimizing patient outcomes.

Purpose of the Study:

• To characterize real-world TTM practices in acute brain injury.
• To investigate associations between TTM parameters, coagulopathy, and in-hospital mortality.
• To explore the influence of injury subtype on TTM outcomes.

Main Methods:

• Retrospective analysis of 180 patients undergoing TTM for acute brain injury (2011-2024).
• Inclusion criteria: aneurysmal subarachnoid hemorrhage, traumatic brain injury (TBI), intracerebral hemorrhage, or acute infarction.
• Statistical analyses included univariable and multivariable models to assess mortality and coagulopathy predictors.

Main Results:

• In-hospital mortality was 43.3%. Post-cardiac arrest state and coagulopathy were significant mortality predictors.
• Coagulopathy occurred in 11.7% of patients, most frequently in TBI.
• Prolonged TTM duration was linked to lower mortality (OR=0.30, p<0.001), but this requires cautious interpretation due to potential survivorship bias.

Conclusions:

• TTM practices differ significantly across acute brain injury subtypes.
• Coagulopathy is a critical factor associated with increased mortality, particularly in TBI patients.
• Clinical context and injury type are essential considerations for personalized TTM application.