Impact of controlled normothermia following hypothermic targeted temperature management for post-rewarming fever and outcomes in post-cardiac arrest patients: A propensity score-matched analysis from a multicentre registry

Kim, Kiwook; Lee, Byung Kook; Park, Jung Soo; Choi, Seung Phil; Jang, Tae Chang; Oh, Joo Suk

doi:10.1016/j.resuscitation.2021.03.006

“…The brain is a highly temperature-dependent organ with cold tolerance, but high temperatures can create damage to patients' brain function and increase poor neurological prognosis [ 13 ]. Therefore, in order to avoid further damage to brain function and ensure the therapeutic effect after ROSC, active cooling nursing should be given clinically [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Study on the Effects of Optimized Emergency Nursing Combined with Mild Hypothermia Nursing on Neurological Prognosis, Hemodynamics, and Cytokines in Patients with Cardiac Arrest

Wang

¹

,

Wu

²

2022

Evidence-Based Complementary and Alternative Medicine

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Purpose. To study the effects of optimized emergency nursing combined with mild hypothermia nursing on neurological prognosis, hemodynamics, and cytokines in patients with cardiac arrest (CA). Methods. The medical records of 147 patients who were successfully rescued by cardiopulmonary resuscitation (CPR) after CA in our hospital were retrospectively analyzed. The 56 patients admitted in 2020 who received optimized emergency nursing were recorded as the control group; and the 91 patients admitted in 2021 who received optimized emergency nursing combined with mild hypothermia nursing were recorded as the study group. The brain function of the two groups at 72 h after return of spontaneous circulation (ROSC) was analyzed: cerebral performance category (CPC) assessment method. The neurological function of the two groups before nursing and 7, 30, and 90 d after nursing was analyzed: National Institutes of Health Stroke Scale (NISHH) score. The vital signs of the two groups after 24 h of nursing were analyzed: heart rate, spontaneous breathing rate, and blood oxygen saturation. The hemodynamic indexes of the two groups at 24 hours after nursing were analyzed: mean arterial pressure (MAP), central venous pressure (CVP), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The levels of cytokines of the two groups before nursing and 7 days after nursing were analyzed: tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8). The incidence of complications and the incidence of postresuscitation syndrome (PRS) during the nursing period were compared between the two groups. Results. 72 h after ROSC, the CPC results in the study group were slightly better than those in the control group, but there was no significant difference in the number of cases of CPC Grade 1, CPC Grade 2, CPC Grade 3, CPC Grade 4, and CPC Grade 5 between the two groups P > 0.05 . Before nursing, there was no statistical difference in the NISHH total score between the two groups P > 0.05 . 7, 30, and 90 d after nursing, the NISHH total score between the two groups were lower than those before nursing, and the study group’s score was lower than the control group’s P < 0.05 . 24 h after nursing, the heart rate and spontaneous breathing rate of the study group were lower than those of the control group P < 0.05 , and there was no significant difference in blood oxygen saturation between the two groups P > 0.05 . 24 h after nursing, there was no significant difference in MAP, CVP, SBP, and DBP between the two groups P > 0.05 . Before nursing, there was no significant difference in the levels of TNF-α, IL-6, and IL-8 between the two groups P > 0.05 . 7 d after nursing, the levels of TNF-α, IL-6, and IL-8 between the two groups were lower than those before nursing, and the levels of the study group were lower than those of the control group P < 0.05 . During the nursing period, the total complication rates of the control group and the study group were 55.36% and 34.07%, respectively, with statistical difference P < 0.05 . During the nursing period, the incidences of PRS in the control group and the study group were 12.50% and 3.30%, respectively, with significant difference P < 0.05 . Conclusion. The application of optimized emergency nursing combined with mild hypothermia nursing in CA can effectively improve the neurological prognosis and inflammatory levels of patients and reduce the incidence of body complications and PRS.

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“…PRF reflects higher heat generation and preserved thermoregulatory function, which suggests less severe brain injury than that in patients with lower post-rewarming body temperatures. [27] This explanation was supported by the study conducted by Lee et al [19] that the prevalence of PRF was associated with favorable CA prognosis indicators, such as younger age and lower SOFA scores.…”

Section: Discussionmentioning

confidence: 84%

“…There is no sufficient evidence to support temperature control in CA patients after rewarming following TTM. [8,27] Previous studies on the infl uence of PRF on neurological outcomes have shown conflicting results. Some studies have suggested that PRF is related to unfavorable neurological outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis

Guo¹

2023

World J Emerg Med

0

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BACKGROUND: Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between postrewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the infl uence of PRF on patients with CA.METHODS: EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random eff ects model or fi xed eff ects model to calculate the pooled odds ratios (ORs) and corresponding 95% confi dence intervals (CIs). The outcome data were unfavorable neurological outcome and mortality. RESULTS:The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no eff ect on the neurological outcome of CA patients (OR 0.71, 95% CI 0.43-1.17, I 2 82%) and has a signifi cant relationship with lower mortality (OR 0.63; 95% CI 0.49-0.80, I 2 39%). However, PRF with a stricter defi nition (body temperature >38.5 °C ) was associated with worse neurological outcome (OR 1.44, 95% CI 1.08-1.92, I 2 45%) and higher mortality (OR 1.71, 95% CI 1.25-2.35, I 2 47%).CONCLUSION: This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. However, PRF >38.5 °C is a potential prognostic factor for worse outcomes in CA patients.

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“…However, one study indicated that the implementation of controlled normothermia to prevent PRF was not associated with favorable neurological outcome. [34] And in an in vitro study, the prevention of PRF obviously aggravated apoptosis of cells and release of in ammatory factors. [35] This study suggested that PRF was related to activation of in ammatory response and programmed cell death following the ischemia-reperfusion injury caused by CA.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effect of Post-rewarming Fever after Targeted Temperature Management in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

Guo

¹

,

Ma

²

,

Xu

³

et al. 2022

Preprint

0

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Aim: To characterize and summarize the studies regarding the influence of post-rewarming fever on neurological outcome and mortality in cardiac arrest patients. Methods: Two investigators separately screened relevant articles in EMBASE, PubMed, and Cochrane Central databases. Randomized clinical trials (RCTs) and cohort studies that evaluated the influence of post-rewarming fever (PRF) and normothermia in cardiac arrest patients were included. The meta-analysis was performed using a random effects model or a fixed effects model to calculate the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The primary outcome was the unfavorable neurological outcome and the secondary outcome was the mortality. Results: The meta-analysis included 12 studies involving 2,991 patients. Results of quantitative analysis suggested that PRF (body temperature >37.5°C) did not affect the unfavorable neurological outcome of patients with cardiac arrest (OR, 0.82; 95% CI, 0.54-1.25; I2, 81%). Also, PRF (body temperature >37.8°C) was not related to higher mortality of patients with cardiac arrest (OR, 0.86; 95% CI, 0.55-1.34; I2, 74%). However, PRF with higher body temperature (>38.5℃) was associated with higher mortality (OR, 2.22; 95%CI, 1.40- 3.35; I2, 0%). Conclusions: This study suggests that PRF (body temperature >37.5°C) is not related to neurological outcome. And no significant association is found between PRF (body temperature >37.8°C) and mortality. However, PRF is associated with higher mortality when PRF was defined as >38.5℃.

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Impact of controlled normothermia following hypothermic targeted temperature management for post-rewarming fever and outcomes in post-cardiac arrest patients: A propensity score-matched analysis from a multicentre registry

Cited by 8 publications

References 34 publications

Study on the Effects of Optimized Emergency Nursing Combined with Mild Hypothermia Nursing on Neurological Prognosis, Hemodynamics, and Cytokines in Patients with Cardiac Arrest

Study on the Effects of Optimized Emergency Nursing Combined with Mild Hypothermia Nursing on Neurological Prognosis, Hemodynamics, and Cytokines in Patients with Cardiac Arrest

Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis

Clinical Effect of Post-rewarming Fever after Targeted Temperature Management in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

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