Spontaneous hypothermia on intensive care unit admission is a predictor of unfavorable neurological outcome in patients after resuscitation: an observational cohort study

Abstract

IntroductionA large number of patients resuscitated for primary cardiac arrest arrive in the intensive care unit (ICU) with a body temperature < 35.0°C. The aim of this observational cohort study was to determine the association between ICU admission temperature and neurological outcome in this patient group.MethodsDemographics and parameters influencing neurological outcome were retrieved from the charts of all patients resuscitated for primary cardiac arrest and treated with induced mild hypothermia in our ICU from January 2006 until January 2008. Patients were divided into two groups according to their body temperature on ICU admission: a hypothermia group (< 35.0°C) and a non-hypothermia group (≥35.0°C). Neurological outcome after six months was assessed by means of the Glasgow Outcome Score (GOS), with GOS 1 to 3 defined as unfavorable and GOS 4 to 5 as favorable. A logistic regression model was used to analyze the influence of the different parameters on neurological outcome.ResultsThe data of 105 consecutive patients resuscitated for primary cardiac arrest and treated with induced mild hypothermia were analyzed. Median ICU admission temperature was 35.1°C (interquartile range (IQR) 34.3 to 35.7). After six months, 61% of the patients had an unfavorable outcome (59% died and 2% were severely disabled), whereas 39% had a favorable outcome (moderate disability or good recovery). Among patients with spontaneous hypothermia on ICU admission, the percentage with unfavorable outcome was higher (69% versus 50%, P = 0.05). Logistic regression showed that age, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores and spontaneous hypothermia on ICU admission all had an increased odds ratio (OR) for an unfavorable outcome after six months. Spontaneous hypothermia had the strongest association with unfavorable outcome (OR 2.6, 95% CI (confidence interval) 1.1 to 5.9), which became even stronger after adjustment for age, presenting heart rhythm, APACHE II and SOFA scores (OR 3.8, CI 1.3 to 11.0).ConclusionsIn this observational cohort study, spontaneous hypothermia on ICU admission was the strongest predictor of an unfavorable neurological outcome in patients resuscitated for primary cardiac arrest.

Targeted Temperature Management Processes and Outcomes After Out-of-Hospital Cardiac Arrest

“…We found that a higher temperature prior to TTM initiation and a slower rate of cooling were both independently associated with good neurological outcome and survival to hospital discharge. Patients with higher baseline temperatures prior to TTM were significantly associated with good neurologic outcome and survival, a finding that is similar to previous studies (17,20,37,38). Baseline temperatures may represent the extent of neurologic insult after anoxic and reperfusion injury of OHCA, a relationship that has also been recognized in patients with traumatic brain injuries (39,40).…”

Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest

“…The benefit of TH after CA has been demonstrated in randomized studies (5, 33), but spontaneous hypothermia at ICU admission might be a sign of a thermoregulation disorder and may be related to a more severe neurologic injury (34). During TH, overall metabolism and production of carbon dioxide decrease.…”

Pre-Hospital Hypothermia is Not Associated with Increased Survival After Traumatic Brain Injury

“…In addition, when hypothermia develops, the body compensates by producing heat through shivering, leading to increased oxygen consumption by 40%-100%, which can be detrimental in TBI patients [52]. In 2010, de Hartog et al sought to determine the association between ICU admission temperature and neurologic outcome in patients resuscitated after cardiac arrest and found that spontaneous hypothermia had the strongest association for unfavorable outcome (AOR 3.8, CI 1.3-11) compared with their normothermic cohorts [53].…”