Intensive Care Medicine

, Volume 40, Issue 9, pp 1210–1219 | Cite as

The association of targeted temperature management at 33 and 36 °C with outcome in patients with moderate shock on admission after out-of-hospital cardiac arrest: a post hoc analysis of the Target Temperature Management trial

  • Martin Annborn
  • John Bro-Jeppesen
  • Niklas Nielsen
  • Susann Ullén
  • Jesper Kjaergaard
  • Christian Hassager
  • Michael Wanscher
  • Jan Hovdenes
  • Tommaso Pellis
  • Paolo Pelosi
  • Matt P. Wise
  • Tobias Cronberg
  • David Erlinge
  • Hans Friberg
  • The TTM-trial investigators
Seven-Day Profile Publication

Abstract

Purpose

We hypothesized that a targeted temperature of 33 °C as compared to that of 36 °C would increase survival and reduce the severity of circulatory shock in patients with shock on admission after out-of-hospital cardiac arrest (OHCA).

Methods

The recently published Target Temperature Management trial (TTM-trial) randomized 939 OHCA patients with no difference in outcome between groups and no difference in mortality at the end of the trial in a predefined subgroup of patients with shock at admission. Shock was defined as a systolic blood pressure of <90 mm Hg for >30 min or the need of supportive measures to maintain a blood pressure ≥90 mmHg and/or clinical signs of end-organ hypoperfusion. In this post hoc analysis reported here, we further analyzed the 139 patients with shock at admission; all had been randomized to receive intervention at 33 °C (TTM33; n = 71) or 36 °C (TTM36; n = 68). Primary outcome was 180-day mortality. Secondary outcomes were intensive care unit (ICU) and 30-day mortality, severity of circulatory shock assessed by mean arterial pressure, serum lactate, fluid balance and the extended Sequential Organ Failure assessment (SOFA) score.

Results

There was no significance difference between targeted temperature management at 33 °C or 36 °C on 180-day mortality [log-rank test, p = 0.17, hazard ratio 1.33, 95 % confidence interval (CI) 0.88–1.98] or ICU mortality (61 vs. 44 %, p = 0.06; relative risk 1.37, 95 % CI 0.99–1.91). Serum lactate and the extended cardiovascular SOFA score were higher in the TTM33 group (p < 0.01).

Conclusions

We found no benefit in survival or severity of circulatory shock with targeted temperature management at 33 °C as compared to 36 °C in patients with shock on admission after OHCA.

Keywords

Cardiac arrest Cardiogenic shock Circulatory failure Post-cardiac arrest syndrome Outcome Hypothermia 

Supplementary material

134_2014_3375_MOESM1_ESM.pdf (549 kb)
Supplementary material 1 (PDF 548 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Martin Annborn
    • 1
    • 2
  • John Bro-Jeppesen
    • 3
  • Niklas Nielsen
    • 2
    • 4
  • Susann Ullén
    • 5
  • Jesper Kjaergaard
    • 3
  • Christian Hassager
    • 3
  • Michael Wanscher
    • 6
  • Jan Hovdenes
    • 7
  • Tommaso Pellis
    • 8
  • Paolo Pelosi
    • 9
    • 13
  • Matt P. Wise
    • 10
  • Tobias Cronberg
    • 2
    • 11
  • David Erlinge
    • 2
    • 12
  • Hans Friberg
    • 1
    • 2
  • The TTM-trial investigators
  1. 1.Department of Intensive and Perioperative CareSkåne University HospitalLundSweden
  2. 2.Department of Clinical SciencesLund UniversityLundSweden
  3. 3.Department of Cardiology, The Heart CentreCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
  4. 4.Department of Anaesthesia and Intensive CareHelsingborg General HospitalHelsingborgSweden
  5. 5.R & D Centre SkåneSkåne University HospitalLundSweden
  6. 6.Department of Cardiothoracic Anaesthesia, The Heart CentreCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
  7. 7.Department of Anesthesiology, RikshospitaletOslo University HospitalOsloNorway
  8. 8.Emergency Medical Service, Anaesthesia and Intensive CareSanta Maria degli Angeli HospitalPordenoneItaly
  9. 9.Department of Surgical Sciences and Integrated DiagnosticsUniversity of GenoaGenoaItaly
  10. 10.Adult Critical CareUniversity Hospital of WalesCardiffUK
  11. 11.Department of NeurologySkåne University HospitalLundSweden
  12. 12.Department of CardiologySkåne University HospitalLundSweden
  13. 13.Anaesthesia and Intensive Care UnitIRCCS San Martino–IST HospitalGenoaItaly

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