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

Abstract

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.

Prognostic value of targeted temperature management on outcomes of hanging-induced out-of-hospital cardiac arrest

“…[13,[40][41][42][43] Therefore, CC methods are known to less effective than CD in minimizing hypoxic brain injury of postcardiac arrest patients. [44,45] However, the relationship between these cooling methods of TTM and clinical outcomes of patients is insignificant in this study. None of only CC, CC + CD, or only CD showed better outcomes compared with patients not treated with TTM.…”

“…Witnessed cardiac arrest, in addition to prehospital ROSC, has been reported to be a good predictive factor in cardiac arrest patients. [20,45] Thus, we conducted a subgroup analysis for the witnessed cardiac arrest and prehospital ROSC. In all subgroups, however, this investigation found that TTM was not related with improved patient outcomes as compared to non-TTM.…”

A Study on the Outcome of Targeted Temperature Management Comparing Cardiac Arrest Patients Who Received Bystander Cardiopulmonary Resuscitation With Those Who Did Not, Using the Nationwide TIMECARD Multicenter Registry

“…Although immediate coronary angiography could delay TTM therapy for ~1 h ( 18 ), current guidelines recommend immediate coronary angiography and percutaneous coronary intervention in resuscitated OHCA patients whose ECGs show ST-elevation myocardial infarction ( 19 ). Given that hemodynamic instability and cardiac dysfunction could worsen during TTM, percutaneous coronary intervention could provide better outcomes in TTM recipients by allowing revascularization of the coronary artery and supporting the hemodynamic status during post-resuscitation care ( 4 ).…”

“…The neuroprotective effects of TTM can be influenced by several factors, including the initial rhythm of cardiac arrest, pre-admission ROSC, the provision of percutaneous coronary intervention, the cooling method for the maintenance phase of TTM, and bystander cardiopulmonary resuscitation (BCPR) ( 4 , 5 ). BCPR provides blood circulation to vital organs after cardiac arrest, thus reducing the risk of brain damage.…”

Intravascular Versus Surface Cooling in Patients Resuscitated From Cardiac Arrest: A Systematic Review and Network Meta-Analysis With Focus on Temperature Feedback

“…Of these, 30 further studies (one RCT [19] and 29 non-RCTs) were excluded after the full-text screening. Three non-RCTs were partially using the same data from the Korean Centers for Disease Control and Prevention out-of-hospital cardiac arrest registry (20)(21)(22). We included the study with most comprehensive study database (22).…”