To determine the association between targeted temperature management
goal temperature of 33°C versus 36°C and neurologic outcome after out-of-hospital cardiac arrest
This was a retrospective, before-and-after, cohort study.
Urban, academic, level 1 trauma center from 2010 to 2017.
Adults with nontraumatic out-of-hospital cardiac arrest
who received targeted temperature management
Our primary exposure was targeted temperature management
goal temperature, which was changed from 33°C to 36°C in April of 2014 at the study hospital. Primary outcome was neurologically intact survival to discharge. Secondary outcomes included hospital mortality and care processes.
Measurements and Main Results:
Of 782 out-of-hospital cardiac arrest
patients transported to the study hospital, 453 (58%) received targeted temperature management
. Of these, 258 (57%) were treated during the 33°C period (targeted temperature management
33°C) and 195 (43%) were treated during the 36°C period (targeted temperature management
36°C). Patients treated during targeted temperature management
33°C were older (57 vs 52 yr; p
< 0.05) and had more arrests of cardiac etiology (45% vs 35%; p
< 0.05), but otherwise had similar baseline characteristics, including initial cardiac rhythm. A total of 40% of patients treated during targeted temperature management
33°C survived with favorable neurologic outcome, compared with 30% in the targeted temperature management
36°C group (p
< 0.05). After adjustment for demographic and cardiac arrest
characteristics, targeted temperature management
33°C was associated with increased odds of neurologically intact survival to discharge (odds ratio, 1.79; 95% CI, 1.09–2.94). Targeted temperature management
33°C was not associated with significantly improved hospital mortality. Targeted temperature management
was implemented faster (1.9 vs 3.5 hr from 911 call; p
< 0.001) and more frequently in the emergency department during the targeted temperature management
33°C period (87% vs 55%; p
Comatose, adult out-of-hospital cardiac arrest
patients treated during the targeted temperature management
33°C period had higher odds of neurologically intact survival to hospital discharge compared with those treated during the targeted temperature management
36°C period. There was no significant difference in hospital mortality.