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Influence of temper...
Influence of temperature management at 33 °C versus normothermia on survival in patients with vasopressor support after out-of-hospital cardiac arrest : a post hoc analysis of the TTM-2 trial
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- Düring, Joachim (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund Univ, Sweden
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- Annborn, Martin (author)
- Lund University,Lunds universitet,Kliniska Vetenskaper, Helsingborg,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Clinical Sciences, Helsingborg,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Helsingborg Hospital,Lund Univ, Sweden
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- Cariou, Alain (author)
- Cochin Hospital,Cochin Univ Hosp, France; Univ Paris, France
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- Chew, Michelle (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Dankiewicz, Josef (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Clin Sci, Cardiol, Sweden
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- Friberg, Hans (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SWECRIT,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital,Lund Univ, Sweden
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- Haenggi, Matthias (author)
- Bern University Hospital,Univ Bern, Switzerland
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- Haxhija, Zana (author)
- Lund University,Lunds universitet,Kliniska Vetenskaper, Helsingborg,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Clinical Sciences, Helsingborg,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund Univ, Sweden
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- Jakobsen, Janus C. (author)
- University of Southern Denmark,Capital Reg Denmark, Denmark; Univ Southern Denmark, Denmark
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- Langeland, Halvor (author)
- St. Olav’s University Hospital,Norwegian University of Science and Technology,St Olavs Univ Hosp, Norway; NTNU, Norway
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- Taccone, Fabio Silvio (author)
- Univ Libre Bruxelles, Belgium
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- Thomas, Matthew (author)
- University Hospitals Bristol NHS Foundation Trust,Univ Hosp Bristol & Weston, England
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- Ullén, Susann (author)
- Skåne University Hospital,Skane Univ Hosp, Sweden
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- Wise, Matt P. (author)
- University Hospital of Wales,Univ Hosp Wales, Wales
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- Nielsen, Niklas (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Kliniska Vetenskaper, Helsingborg,Institutionen för kliniska vetenskaper, Lund,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SEBRA Sepsis and Bacterial Resistance Alliance,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Clinical Sciences, Helsingborg,Department of Clinical Sciences, Lund,Center for cardiac arrest,Lund University Research Groups,Helsingborg Hospital,Lund Univ, Sweden
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(creator_code:org_t)
- 2022-07-31
- 2022
- English.
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In: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 26:1
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Abstract
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- Background: Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA. Methods: We performed a post hoc analysis of patients included in the TTM-2 trial, an international, multicenter trial, investigating outcomes in unconscious adult OHCA patients randomized to TTM33 versus normothermia. Patients were grouped according to level of circulatory support on admission: (1) no-vasopressor support, mean arterial blood pressure (MAP) ≥ 70 mmHg; (2) moderate-vasopressor support MAP < 70 mmHg or any dose of dopamine/dobutamine or noradrenaline/adrenaline dose ≤ 0.25 µg/kg/min; and (3) high-vasopressor support, noradrenaline/adrenaline dose > 0.25 µg/kg/min. Hazard ratios with TTM33 were calculated for all-cause 180-day mortality in these groups. Results: The TTM-2 trial enrolled 1900 patients. Data on primary outcome were available for 1850 patients, with 662, 896, and 292 patients in the, no-, moderate-, or high-vasopressor support groups, respectively. Hazard ratio for 180-day mortality was 1.04 [98.3% CI 0.78–1.39] in the no-, 1.22 [98.3% CI 0.97–1.53] in the moderate-, and 0.97 [98.3% CI 0.68–1.38] in the high-vasopressor support groups with regard to TTM33. Results were consistent in an imputed, adjusted sensitivity analysis. Conclusions: In this exploratory analysis, temperature control at 33 °C after OHCA, compared to normothermia, was not associated with higher incidence of death in patients stratified according to vasopressor support on admission. Trial registration Clinical trials identifier NCT02908308, registered September 20, 2016.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Keyword
- Cardiac arrest
- Heart arrest
- Hypothermia induced
- Mortality
- Shock
- Sudden
- Heart arrest; Cardiac arrest; Sudden; Hypothermia induced; Shock; Mortality
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Düring, Joachim
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Annborn, Martin
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Cariou, Alain
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Chew, Michelle
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Dankiewicz, Jose ...
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Friberg, Hans
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Haenggi, Matthia ...
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Haxhija, Zana
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Jakobsen, Janus ...
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Langeland, Halvo ...
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Taccone, Fabio S ...
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Thomas, Matthew
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Ullén, Susann
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Wise, Matt P.
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Nielsen, Niklas
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Critical Care
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Lund University
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Linköping University