Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?
Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardi...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/7/2628 |
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| author | I-Ting Wang Chieh-Jen Wang Chao-Hsien Chen Sheng-Hsiung Yang Chun-Yen Chen Yen-Chun Huang Chang-Yi Lin Chien-Liang Wu |
| author_facet | I-Ting Wang Chieh-Jen Wang Chao-Hsien Chen Sheng-Hsiung Yang Chun-Yen Chen Yen-Chun Huang Chang-Yi Lin Chien-Liang Wu |
| author_sort | I-Ting Wang |
| collection | DOAJ |
| description | Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, <i>p</i> = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; <i>p</i> = 0.001) and survival at 28 days (58.06% vs. 29.25%; <i>p</i> = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM. |
| first_indexed | 2024-03-11T05:32:48Z |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T05:32:48Z |
| publishDate | 2023-03-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-6657d65b1fe94094906f7de08f6c6c332023-11-17T16:59:43ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01127262810.3390/jcm12072628Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?I-Ting Wang0Chieh-Jen Wang1Chao-Hsien Chen2Sheng-Hsiung Yang3Chun-Yen Chen4Yen-Chun Huang5Chang-Yi Lin6Chien-Liang Wu7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, TaiwanDivision of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, TaiwanGraduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242062, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, TaiwanTargeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, <i>p</i> = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; <i>p</i> = 0.001) and survival at 28 days (58.06% vs. 29.25%; <i>p</i> = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM.https://www.mdpi.com/2077-0383/12/7/2628in-hospital cardiac arrestout-of-hospital cardiac arrestpostcardiac arrest syndrometargeted temperature managementtiming |
| spellingShingle | I-Ting Wang Chieh-Jen Wang Chao-Hsien Chen Sheng-Hsiung Yang Chun-Yen Chen Yen-Chun Huang Chang-Yi Lin Chien-Liang Wu Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better? Journal of Clinical Medicine in-hospital cardiac arrest out-of-hospital cardiac arrest postcardiac arrest syndrome targeted temperature management timing |
| title | Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better? |
| title_full | Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better? |
| title_fullStr | Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better? |
| title_full_unstemmed | Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better? |
| title_short | Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better? |
| title_sort | optimal timing of targeted temperature management for post cardiac arrest syndrome is sooner better |
| topic | in-hospital cardiac arrest out-of-hospital cardiac arrest postcardiac arrest syndrome targeted temperature management timing |
| url | https://www.mdpi.com/2077-0383/12/7/2628 |
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