Age‐dependent effect of targeted temperature management on outcome after cardiac arrest

Wallmüller, Christian; Spiel, Alexander; Sterz, Fritz; Schober, Andreas; Hubner, Pia; Stratil, Peter; Testori, Christoph

doi:10.1111/eci.13026

Cited by 16 publications

(19 citation statements)

References 34 publications

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“…However, current guidelines do not differentiate between the management of older and younger patients. There are only a few studies describing the quality and outcome of cardiopulmonary resuscitation (CPR) and post-cardiac arrest therapy in the elderly [16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

The role of age in post-cardiac arrest therapy in an elderly patient population

et al. 2020

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AimWe investigated the effect of age on post-cardiac arrest treatment outcomes in an elderly population, based on a local database and a systemic review of the literature.MethodsData were collected retrospectively from medical charts and reports. Sixty-one comatose patients, cooled to 32–34 °C for 24 h, were categorized into three groups: younger group (≤65 years), older group (66–75 years), and very old group (>75 years). Circumstances of cardiopulmonary resuscitation (CPR), patients' characteristics, post-resuscitation treatment, hemodynamic monitoring, neurologic outcome and survival were compared across age groups. Kruskal-Wallis test, Chi-square test and binary logistic regression (BLR) were applied. In addition, a literature search of PubMed/Medline database was performed to provide a background.ResultsAge was significantly associated with having a cardiac arrest on a monitor and a history of hypertension. No association was found between age and survival or neurologic outcome. Age did not affect hemodynamic parameter changes during target temperature management (TTM), except mean arterial pressure (MAP). Need of catecholamine administration was the highest among very old patients. During the literature review, seven papers were identified. Most studies had a retrospective design and investigated interventions and outcome, but lacked unified age categorization. All studies reported worse survival in the elderly, although old survivors showed a favorable neurologic outcome in most of the cases.ConclusionThere is no evidence to support the limitation of post-cardiac arrest therapy in the aging population. Furthermore, additional prospective studies are needed to investigate the characteristics and outcome of post-cardiac arrest therapy in this patient group.

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Section: Introductionmentioning

confidence: 99%

The role of age in post-cardiac arrest therapy in an elderly patient population

et al. 2020

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“…Winther–Jensen et al [57] reported that older age was associated with increased rates of unfavourable neurological outcomes. As people age, comorbidity, and disability rates increase, [58] and neurological function and neuronal plasticity decline 58 59 ; hence, older patients may respond poorly to TTM.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for neurological outcomes in Korean targeted temperature management recipients with return of spontaneous circulation after out-of-hospital cardiac arrests

et al. 2020

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Targeted temperature management (TTM) is recommended for comatose patients after out-of-hospital cardiac arrests (OHCAs). Even after successful TTM, several factors could influence the neuroprotective effect of TTM. The aim of this study is to identify prognostic factors associated with good neurological outcomes in TTM recipients. This study used nationwide data during 2012 to 2016 to investigate prognostic factors associated with good neurological outcomes in patients who received TTM after the return of spontaneous circulation (ROSC). Multivariate logistic regression analysis was conducted to analyse the factors that may affect the neurological outcomes in the TTM recipients. The study included 1578 eligible patients, comprising 767 with good and 811 with poor neurological outcomes. Multivariable analyses showed that OHCA in public places (OR, 1.599; 95% CI, 1.100–2.323, P = .014), initial shockable rhythms (OR, 1.721; 95% CI, 1.191–2.486, P = .004), pre-hospital ROSCs (OR, 6.748; 95% CI, 4.703–9.682, P < .001), bystander cardiopulmonary resuscitation (CPR) (OR, 1.715; 95% CI, 1.200–2.450, P = .003), and primary coronary interventions (PCIs) (OR, 2.488; 95% CI, 1.639–3.778, P < .001) were statistically significantly associated with good neurological outcomes. Whereas, increase of age (OR, 0.962; 95% CI, 0.950–0.974, P < .001) and conventional cooling (OR, 0.478; 95% CI, 0.255–0.895, P = .021) were statistically significantly associated with poor neurological outcome. This study suggests that being younger, experiencing OHCA in public places, having initial shockable rhythm, pre-hospital ROSC, and bystander CPR, implementing PCIs and applying intravascular or surface cooling devices compared to conventional cooling method could predict good neurological outcomes in post-cardiac arrest patients who received TTM.

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“…74 Another similar study included 1885 OHCA patients, 921 were treated with TTM (32–34°C), and determined that TTM was not associated with good outcome in patients over the age of 65 (OR < 1.5). 75 Conversely, a Korean registry-based retrospective analysis including 161 matched pairs of OHCA patients found that endovascular cooling was associated with good neurological outcomes for patients 65 or older. 76…”

Section: Confounding Factors Influencing Outcome After Ca and Ttmmentioning

confidence: 99%

Targeted temperature management and early neuro-prognostication after cardiac arrest

Chen

Lachance

Gao

et al. 2021

J Cereb Blood Flow Metab

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Targeted temperature management (TTM) is a recommended neuroprotective intervention for coma after out-of-hospital cardiac arrest (OHCA). However, controversies exist concerning the proper implementation and overall efficacy of post-CA TTM, particularly related to optimal timing and depth of TTM and cooling methods. A review of the literature finds that optimizing and individualizing TTM remains an open question requiring further clinical investigation. This paper will summarize the preclinical and clinical trial data to-date, current recommendations, and future directions of this therapy, including new cooling methods under investigation. For now, early induction, maintenance for at least 24 hours, and slow rewarming utilizing endovascular methods may be preferred. Moreover, timely and accurate neuro-prognostication is valuable for guiding ethical and cost-effective management of post-CA coma. Current evidence for early neuro-prognostication after TTM suggests that a combination of initial prediction models, biomarkers, neuroimaging, and electrophysiological methods is the optimal strategy in predicting neurological functional outcomes.

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Age‐dependent effect of targeted temperature management on outcome after cardiac arrest

Cited by 16 publications

References 34 publications

The role of age in post-cardiac arrest therapy in an elderly patient population

The role of age in post-cardiac arrest therapy in an elderly patient population

Prognostic factors for neurological outcomes in Korean targeted temperature management recipients with return of spontaneous circulation after out-of-hospital cardiac arrests

Targeted temperature management and early neuro-prognostication after cardiac arrest

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