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Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial*

Salter, Ryan, FANZCA1; Bailey, Michael, PhD2–4; Bellomo, Rinaldo, MD2,3,5; Eastwood, Glenn, PhD2,5; Goodwin, Andrew, BEng (Env)6; Nielsen, Niklas, PhD7,8; Pilcher, David, FCICM2,9,10; Nichol, Alistair, PhD2,9,11; Saxena, Manoj, PhD12–14; Shehabi, Yahya, PhD4,15; Young, Paul, PhD1,16 on behalf of the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE)

doi: 10.1097/CCM.0000000000003339
Feature Articles
Data Visualization

Objectives: To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the target temperature management trial.

Design: Retrospective cohort study (January 2005 to December 2016).

Setting: The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient database containing greater than 2 million admission episodes from 186 Australian and New Zealand ICUs.

Patients: Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest.

Interventions: The primary exposure of interest was admission before versus after publication of the target temperature management trial.

Measurements and Main Results: The primary outcome variable to evaluate changes in temperature management was lowest temperature in the first 24 hours in ICU. The primary clinical outcome variable of interest was inhospital mortality. Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU. Mean ± SD lowest temperature in the first 24 hours in ICU in pre- and posttarget temperature management trial patients was 33.80 ± 1.71°C and 34.70 ± 1.39°C, respectively (absolute difference, 0.98°C [99% CI, 0.89–1.06°C]). Inhospital mortality rate decreased by 1.3 (99% CI, –1.8 to –0.9) percentage points per year from January 2005 until December 2013 and increased by 0.6 (99% CI, –1.4 to 2.6) percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99% CI, –0.6 to 4.4]). Fever occurred in 568 (12.8%) of 4,450 pretarget temperature management trial patients and 853 (16.5%) of 5,184 posttarget temperature management trial patients (odds ratio, 1.35 [99% CI, 1.16–1.57]).

Conclusions: The average lowest temperature of postcardiac arrest patients in the first 24 hours in ICU rose after publication of the target temperature management trial. This change was associated with an increased frequency of fever not seen in the target temperature management trial.

1Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.

2Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, VIC, Australia.

3School of Medicine, University of Melbourne, Melbourne, VIC, Australia.

4School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.

5Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia.

6Faculty of Engineering and Information Technologies, University of Sydney, Sydney, NSW, Australia.

7Department of Clinical Sciences, Lund University, Lund, Sweden.

8Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.

9Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia.

10Division of Critical Care and Trauma, The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia.

11University College Dublin-Clinical Research Centre at St Vincent’s University Hospital, Dublin, Ireland.

12Division of Critical Care and Trauma, George Institute for Global Health, Sydney, NSW, Australia.

13St George Clinical School, University of New South Wales, NSW, Australia.

14Intensive Care Unit, St George Hospital, Sydney, NSW, Australia.

15Intensive Care Unit, Monash Medical Centre, Melbourne, VIC, Australia.

16Medical Research Institute of New Zealand, Wellington, New Zealand.

*See also p. 1864.

Members of the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE) are listed in the supplementary materials (Supplemental Digital Content 1, http://links.lww.com/CCM/D847).

Drs. Bailey and Young had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Salter and Young drafted the article. Dr. Bailey analyzed the statistical data. Dr. Goodwin developed the dynamic data visualization. Dr. Young conceptualized and designed the study and obtained funding. All authors acquired, analyzed, or interpreted the data and critically revised the article for important intellectual content.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

This study was completed during the tenure of a Clinical Practitioner Fellowship funded by the Health Research Council of New Zealand held by Dr. Young. The Medical Research Institute of New Zealand is funded by independent research organization funding from the Health Research Council of New Zealand.

Dr. Nielsen received funding from Bard Medical (lecture fees) and Braincool Advisory board. Dr. Nichol disclosed that he is supported by the Health Research Board of Ireland Clinical Trial Network funding. Dr. Saxena’s institution received funding for article research from the National Health and Medical Research Council Early Career Fellowship and Bard Medical (consultancy and invited lectures). Intensive Care Foundation Project Grant. Dr. Young received funding from Bard Medical for lecture fees. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: paul.young@ccdhb.org.nz

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