TY - JOUR
T1 - Temporal trends in the use of targeted temperature management after cardiac arrest and association with outcome
T2 - Insights from the Paris Sudden Death Expertise Centre
AU - and on behalf of the SDEC
AU - Lascarrou, Jean Baptiste
AU - Dumas, Florence
AU - Bougouin, Wulfran
AU - Chocron, Richard
AU - Beganton, Frankie
AU - Legriel, Stephane
AU - Aissaoui, Nadia
AU - Deye, Nicolas
AU - Lamhaut, Lionel
AU - Jost, Daniel
AU - Vieillard-Baron, Antoine
AU - Marijon, Eloi
AU - Jouven, Xavier
AU - Cariou, Alain
AU - Waldmann, V.
AU - Adnet, F.
AU - Agostinucci, J. M.
AU - Aissaoui-Balanant, N.
AU - Algalarrondo, V.
AU - Alla, F.
AU - Alonso, C.
AU - Amara, W.
AU - Annane, D.
AU - Antoine, C.
AU - Aubry, P.
AU - Azoulay, E.
AU - Beganton, F.
AU - Benhamou, D.
AU - Billon, C.
AU - Bougouin, W.
AU - Boutet, J.
AU - Bruel, C.
AU - Bruneval, P.
AU - Carli, P.
AU - Casalino, E.
AU - Cerf, C.
AU - Chaib, A.
AU - Cholley, B.
AU - Cohen, Y.
AU - Combes, A.
AU - Crahes, M.
AU - Da Silva, D.
AU - Das, V.
AU - Demoule, A.
AU - Denjoy, I.
AU - Deye, N.
AU - Dhonneur, G.
AU - Diehl, J. L.
AU - Dinanian, S.
AU - Domanski, L.
N1 - Publisher Copyright:
© 2019 The Author(s).
PY - 2019/12/3
Y1 - 2019/12/3
N2 - Purpose: Recent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome. Methods: We used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale. Results: Between May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome. Conclusions: We report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in "no flow" duration.
AB - Purpose: Recent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome. Methods: We used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale. Results: Between May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome. Conclusions: We report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in "no flow" duration.
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U2 - 10.1186/s13054-019-2677-1
DO - 10.1186/s13054-019-2677-1
M3 - Article
C2 - 31796127
AN - SCOPUS:85076099022
SN - 1364-8535
VL - 23
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 391
ER -