Skip to main content


Log in

Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript



Few outcome data are available about temperature management after intraoperative cardiac arrest (IOCA). We describe targeted temperature management (TTM) (32–34 °C) modalities, adverse events, and association with 1-year functional outcome in patients with IOCA.


Patients admitted to 11 ICUs after IOCA in 2008–2013 were studied retrospectively. The main outcome measure was 1-year functional outcome.


Of the 101 patients [35 women and 66 men; median age, 62 years (interquartile range, 42–72)], 68 (67.3%) were ASA PS I to III and 57 (56.4%) had emergent surgery. First recorded rhythms were asystole in 44 (43.6%) patients, pulseless electrical activity in 36 (35.6%), and ventricular fibrillation/tachycardia in 20 (19.8%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation (ROSC) were 0 min (0–0) and 10 min (4–20), respectively. The 30 (29.7%) patients who received TTM had an increased risk of infection (P = 0.005) but not of arrhythmia, bleeding, or metabolic/electrolyte disorders. By multivariate analysis, one or more defibrillation before ROSC was positively associated with a favorable functional outcome at 1-year (OR 3.06, 95% CI 1.05–8.95, P = 0.04) and emergency surgery was negatively associated with 1-year favorable functional outcome (OR 0.36; 95% CI 0.14–0.95, P = 0.038). TTM use was not independently associated with 1-year favorable outcome (OR 0.82; 95% CI 0.27–2.46, P = 0.72).


TTM was used in less than one-third of patients after IOCA. TTM was associated with infection but not with bleeding or coronary events in this setting. TTM did not independently predict 1-year favorable functional outcome after IOCA in this study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Accessed 14 September 2016.


  1. Nunnally ME, O’Connor MF, Kordylewski H, Westlake B, Dutton RP (2015) The incidence and risk factors for perioperative cardiac arrest observed in the national anesthesia clinical outcomes registry. Anesth Analg 120:364–370

    Article  PubMed  Google Scholar 

  2. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, Meaney PA, Cen L, Nadkarni VM, Praestgaard AH, Berg RA (2008) Survival from in-hospital cardiac arrest during nights and weekends. JAMA 299:785–792

    Article  CAS  PubMed  Google Scholar 

  3. Sprung J, Warner ME, Contreras MG, Schroeder DR, Beighley CM, Wilson GA, Warner DO (2003) Predictors of survival following cardiac arrest in patients undergoing noncardiac surgery: a study of 518,294 patients at a tertiary referral center. Anesthesiology 99:259–269

    Article  PubMed  Google Scholar 

  4. Kheterpal S, O’Reilly M, Englesbe MJ, Rosenberg AL, Shanks AM, Zhang L, Rothman ED, Campbell DA, Tremper KK (2009) Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology 110:58–66

    Article  PubMed  Google Scholar 

  5. Goswami S, Brady JE, Jordan DA, Li G (2012) Intraoperative cardiac arrests in adults undergoing noncardiac surgery: incidence, risk factors, and survival outcome. Anesthesiology 117:1018–1026

    Article  PubMed  Google Scholar 

  6. Kawashima Y, Takahashi S, Suzuki M, Morita K, Irita K, Iwao Y, Seo N, Tsuzaki K, Dohi S, Kobayashi T, Goto Y, Suzuki G, Fujii A, Suzuki H, Yokoyama K, Kugimiya T (2003) Anesthesia-related mortality and morbidity over a 5-year period in 2,363,038 patients in Japan. Acta Anaesthesiol Scand 47:809–817

    Article  CAS  PubMed  Google Scholar 

  7. Ramachandran SK, Mhyre J, Kheterpal S, Christensen RE, Tallman K, Morris M, Chan PS, American Heart Association’s Get With The Guidelines-Resuscitation Investigators (2013) Predictors of survival from perioperative cardiopulmonary arrests: a retrospective analysis of 2524 events from the Get With The Guidelines-Resuscitation registry. Anesthesiology 119:1322–1339

    Article  PubMed  Google Scholar 

  8. Constant AL, Montlahuc C, Grimaldi D, Pichon N, Mongardon N, Bordenave L, Soummer A, Sauneuf B, Ricome S, Misset B, Schnell D, Dubuisson E, Brunet J, Lasocki S, Cronier P, Bouhemad B, Loriferne JF, Begot E, Vandenbunder B, Dhonneur G, Bedos JP, Jullien P, Resche-Rigon M, Legriel S (2014) Predictors of functional outcome after intraoperative cardiac arrest. Anesthesiology 121:482–491

    Article  PubMed  Google Scholar 

  9. The Hypothermia After Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556

  10. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563

    Article  PubMed  Google Scholar 

  11. Cariou A, Nolan JP, Sunde K (2015) Ten strategies to increase survival of cardiac arrest patients. Intensive Care Med 41:1820–1823

    Article  PubMed  Google Scholar 

  12. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Aneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Kober L, Langorgen J, Lilja G, Moller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H, TTM Trial Investigators (2013) Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 369:2197–2206

    Article  CAS  PubMed  Google Scholar 

  13. Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, Castren M, de Caen AR, Ferrer JM, Finn JC, Gent LM, Griffin RE, Iverson S, Lang E, Lim SH, Maconochie IK, Montgomery WH, Morley PT, Nadkarni VM, Neumar RW, Nikolaou NI, Perkins GD, Perlman JM, Singletary EM, Soar J, Travers AH, Welsford M, Wyllie J, Zideman DA (2015) Part 1: executive summary: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 132:S2–S39

    Article  PubMed  Google Scholar 

  14. Nolan JP (2013) What’s new in the management of cardiac arrest? Intensive Care Med 39:1211–1213

    Article  PubMed  Google Scholar 

  15. Sessler DI (2001) Complications and treatment of mild hypothermia. Anesthesiology 95:531–543

    Article  CAS  PubMed  Google Scholar 

  16. Polderman KH (2009) Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 37:S186–S202

    Article  PubMed  Google Scholar 

  17. Keats AS (1978) The ASA classification of physical status–a recapitulation. Anesthesiology 49:233–236

    Article  CAS  PubMed  Google Scholar 

  18. An JX, Zhang LM, Sullivan EA, Guo QL, Williams JP (2011) Intraoperative cardiac arrest during anesthesia: a retrospective study of 218,274 anesthetics undergoing non-cardiac surgery. Chin Med J (Engl) 124:227–232

    Google Scholar 

  19. O’Connor C (1995) Intraoperative cardiac arrest. Anesthesiol Clin N Am 13:905–922

    Google Scholar 

  20. Gasparetto N, Scarpa D, Rossi S, Persona P, Martano L, Bianchin A, Castioni CA, Ori C, Iliceto S, Cacciavillani L (2014) Therapeutic hypothermia in Italian intensive care units after 2010 resuscitation guidelines: still a lot to do. Resuscitation 85:376–380

    Article  PubMed  Google Scholar 

  21. Storm C, Meyer T, Schroeder T, Wutzler A, Jorres A, Leithner C (2014) Use of target temperature management after cardiac arrest in Germany—a nationwide survey including 951 intensive care units. Resuscitation 85:1012–1017

    Article  CAS  PubMed  Google Scholar 

  22. Dumas F, Grimaldi D, Zuber B, Fichet J, Charpentier J, Pene F, Vivien B, Varenne O, Carli P, Jouven X, Empana JP, Cariou A (2011) Is hypothermia after cardiac arrest effective in both shockable and nonshockable patients? Insights from a large registry. Circulation 123:877–886

    Article  PubMed  Google Scholar 

  23. Weidman JL, Shook DC, Hilberath JN (2014) Cardiac resuscitation and coagulation. Anesthesiology 120:1009–1014

    Article  PubMed  Google Scholar 

  24. Stockmann H, Krannich A, Schroeder T, Storm C (2014) Therapeutic temperature management after cardiac arrest and the risk of bleeding: systematic review and meta-analysis. Resuscitation 85:1494–1503

    Article  PubMed  Google Scholar 

  25. Mongardon N, Perbet S, Lemiale V, Dumas F, Poupet H, Charpentier J, Pene F, Chiche JD, Mira JP, Cariou A (2011) Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era. Crit Care Med 39:1359–1364

    Article  PubMed  Google Scholar 

  26. Perbet S, Mongardon N, Dumas F, Bruel C, Lemiale V, Mourvillier B, Carli P, Varenne O, Mira JP, Wolff M, Cariou A (2011) Early-onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis. Am J Respir Crit Care Med 184:1048–1054

    Article  PubMed  Google Scholar 

  27. Tsai MS, Chiang WC, Lee CC, Hsieh CC, Ko PC, Hsu CY, Su CP, Chen SY, Chang WT, Yuan A, Ma MH, Chen SC, Chen WJ (2005) Infections in the survivors of out-of-hospital cardiac arrest in the first 7 days. Intensive Care Med 31:621–626

    Article  PubMed  Google Scholar 

  28. Kakavas S, Mongardon N, Cariou A, Gulati A, Xanthos T (2015) Early-onset pneumonia after out-of-hospital cardiac arrest. J Infect 70:553–562

    Article  CAS  PubMed  Google Scholar 

  29. Dumas F, Bougouin W, Geri G, Lamhaut L, Bougle A, Daviaud F, Morichau-Beauchant T, Rosencher J, Marijon E, Carli P, Jouven X, Rea TD, Cariou A (2014) Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients? J Am Coll Cardiol 64:2360–2367

    Article  CAS  PubMed  Google Scholar 

  30. Legriel S, Bruneel F, Sediri H, Hilly J, Abbosh N, Lagarrigue MH, Troche G, Guezennec P, Pico F, Bedos JP (2009) Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study. Neurocrit Care 11:338–344

    Article  PubMed  Google Scholar 

Download references


We thank A. Wolfe MD (Issy-les-Moulineaux, France) for helping to prepare the manuscript.

Author contribution

SL, A-LC, and NM conceived, designed, and supervised the trial. SL, A-LC, DG, NM, NP, PC, SR, BS, JB, ED, AS, BV, EB, JL, BM, BB, DS, SM, SL, and BS collected the data; and SL coordinated the data collection. SL, CM, QM, and MRR analyzed and interpreted the data. CM, QM, and MRR performed the statistical analysis. SL, ALC, and NM wrote the first draft of the paper. All authors approved the final version of the manuscript.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Stephane Legriel.

Ethics declarations


The study was supported by the French public funding agency Délégation à la Recherche Clinique et à l’Innovation (DRCI), Versailles, France.

Conflicts of interest

The authors declare no competing interests.

Additional information

Take-home message: TTM is used in less than one-third of patients after IOCA. Although 1-year functional outcome was lower in patients given TTM, TTM did not independently predict better functional outcome after IOCA in this study.

Electronic supplementary material

Below is the link to the electronic supplementary material.


ESM Table 1. Year of intraoperative cardiac arrest occurrence in patients managed with and without targeted temperature management – 2000 to 2013 (TIFF 16875 kb)


ESM Table 2. Causes of intraoperative cardiac arrest surgery in the 101 survivors admitted to the intensive care unit (DOCX 38 kb)

ESM Table 3. Temperature in the operating room in 101 patients with intraoperative cardiac arrest (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Constant, AL., Mongardon, N., Morelot, Q. et al. Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study. Intensive Care Med 43, 485–495 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: