Temperature variability during targeted temperature management is not associated with neurological outcomes following cardiac arrest

Nayeri, Arash; Bhatia, Nirmanmoh; Holmes, Benjamin; Borges, Nyal; Armstrong, William; Xu, Meng; Farber‐Eger, Eric; Wells, Quinn S.; McPherson, John

doi:10.1016/j.ajem.2017.01.058

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…Previous studies reported the relationship between BT variability and neurologic outcome during the TTM maintenance period (Nobile et al, 2015;Nayeri et al, 2017). In these studies, BT variability in the good outcome group was higher than that in the poor outcome group (Nobile et al, 2015;Nayeri et al, 2017), a finding similar to that in the present study. However, in the present study, BT variability was not associated with neurologic outcome in the multivariate analysis.…”

Section: Discussionsupporting

confidence: 89%

“…Previous studies showed that the TTM induction time or initial BT was related to the neurologic outcome (Perman et al, 2015;Hovdenes et al, 2016). Studies have also assessed the relationship between BT variability and neurologic outcome during the TTM maintenance period (Nobile et al, 2015;Nayeri et al, 2017). In those studies, although BT variability was not associated with neurologic outcome in the multivariate analysis, BT variability was higher in patients with good outcomes compared with those with poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C

Ryu

Lee

et al. 2022

Therapeutic Hypothermia and Temperature Management

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We examined the association between variability in body temperature (BT) and water temperature (WT) during the maintenance period of targeted temperature management (TTM) and neurologic outcomes in out-of-hospital cardiac arrest (OHCA) survivors. Adult (q18 years), comatose OHCA survivors who underwent TTM at 33°C between October 2015 and December 2019 were included. We collected data on BT and WT recorded every minute during the TTM maintenance period. Temperature variability was measured as the standard deviation of BT and WT during the 33°C maintenance period. The primary outcome was a poor neurologic outcome, defined as a cerebral performance category scale 3-5 at 6 months. Of the 154 included patients, 96 (62.3%) had poor outcomes. The BT variability in the poor outcome group was lower than that in the good outcome group (0.16°C [0.13-0.27°C] vs. 0.13°C [0.11-0.18°C]). In addition, the WT variability during the maintenance period in the poor outcome group was lower than that in the good outcome group (2.24°C [1.80-3.96°C] vs. 1.77°C [1.26-2.32°C]). In the multivariate analysis, WT variability (odds ratio 0.508; 95% confidence interval, 0.295-0.874; p = 0.014) was independently associated with poor neurologic outcome. BT variability and cooling beyond 33.0°C -1.0°C were not associated with poor neurologic outcomes. WT variability during the maintenance period was independently associated with neurologic outcomes in OHCA survivors who underwent TTM at 33°C. In addition, overcooling or undercooling during the maintenance period was not associated with neurologic outcomes.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C

Ryu

Lee

et al. 2022

Therapeutic Hypothermia and Temperature Management

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“…As such, the main difference between the core and invasive methods, in particular EC, was associated with a more strict maintenance of the target temperature during the cooling phase, fewer periods of over-cooling or unexpected rewarming and less temperature variability [14, 19, 25]. Importantly, temperature variability after CA has not been associated with poor neurological outcome in two retrospective studies [41, 42]. Considering also the higher risk of side effects (i.e., infections, thrombosis, hemorrhage) associated with the use of core and invasive TTM systems, in particular EC [12, 24, 43], further studies evaluating the mechanisms involved in potential neuroprotection for such methods are necessary.…”

Section: Discussionmentioning

confidence: 99%

Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis

et al. 2019

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Background Although targeted temperature management (TTM) is recommended in comatose survivors after cardiac arrest (CA), the optimal method to deliver TTM remains unknown. We performed a meta-analysis to evaluate the effects of different TTM methods on survival and neurological outcome after adult CA. Methods We searched on the MEDLINE/PubMed database until 22 February 2019 for comparative studies that evaluated at least two different TTM methods in CA patients. Data were extracted independently by two authors. We used the Newcastle-Ottawa Scale and a modified Cochrane ROB tools for assessing the risk of bias of each study. The primary outcome was the occurrence of unfavorable neurological outcome (UO); secondary outcomes included overall mortality. Results Our search identified 6886 studies; 22 studies ( n = 8027 patients) were included in the final analysis. When compared to surface cooling, core methods showed a lower probability of UO (OR 0.85 [95% CIs 0.75–0.96]; p = 0.008) but not mortality (OR 0.88 [95% CIs 0.62–1.25]; p = 0.21). No significant heterogeneity was observed among studies. However, these effects were observed in the analyses of non-RCTs. A significant lower probability of both UO and mortality were observed when invasive TTM methods were compared to non-invasive TTM methods and when temperature feedback devices (TFD) were compared to non-TFD methods. These results were significant particularly in non-RCTs. Conclusions Although existing literature is mostly based on retrospective or prospective studies, specific TTM methods (i.e., core, invasive, and with TFD) were associated with a lower probability of poor neurological outcome when compared to other methods in adult CA survivors (CRD42019111021). Electronic supplementary material The online version of this article (10.1186/s13054-019-2567-6) contains supplementary material, which is available to authorized users.

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“…20 Studies evaluating temperature fluctuations in human beings were not able to document any effect of fluctuations on neurological outcomes, but no such data are available for laminitis. 21 Further studies in horses are needed to determine if mild or variable hypothermia is sufficient to prevent the onset of laminitis. Based on the available literature in other species, the cryotherapy method evaluated in this study has potential prophylactic and therapeutic benefits in the management of laminitis, despite some temperature fluctuations, by virtue of its ability to achieve a temperature decrease of 18°C compared with control limbs.…”

Section: Discussionmentioning

confidence: 99%

“…Metabolic activity is generally reported to reduce approximately 50 per cent for a 10°C reduction in temperature 20. Studies evaluating temperature fluctuations in human beings were not able to document any effect of fluctuations on neurological outcomes, but no such data are available for laminitis 21. Further studies in horses are needed to determine if mild or variable hypothermia is sufficient to prevent the onset of laminitis.…”

Section: Discussionmentioning

confidence: 99%

Novel dry cryotherapy system for cooling the equine digit

Morgan

Stefanovski

Lenfest

et al. 2018

Veterinary Record Open

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ObjectivesDigital cryotherapy is commonly used for laminitis prophylaxis and treatment. Currently validated methods for distal limb cryotherapy involve wet application or compression technology. There is a need for a practical, affordable, dry cryotherapy method that effectively cools the digit. The objective of this study was to evaluate the hoof wall surface temperatures (HWSTs) achieved with a novel dry cryotherapy technology.DesignRepeated-measures in vivo experimental study.SettingExperimental intervention at a single site.Participants6 systemically healthy horses (3 mares, 3 geldings).InterventionsCryotherapy was applied to six horses for eight hours with a commercially available rubber and rubber and welded fabricice boot, which extended proximally to include the foot and pastern. Reusable malleable cold therapy packs were secured against the foot and pastern with the three built-in hook-and-loop fastener panels.Primary and secondary outcome measuresHWST and pastern surface temperature of the cryotherapy-treated limb, HWST of the control limb and ambient temperature were recorded every five minutes throughout the study period.ResultsResults were analysed with mixed-effects multivariable regression analysis. The HWST (median 11.1°C, interquartile range 8.6°C–14.7°C) in the cryotherapy-treated limb was significantly decreased compared with the control limb (median 29.7°C, interquartile range 28.9°C–30.4°C) (P≤0.001). Cryotherapy limb HWST reached a minimum of 6.75°C (median) with an interquartile range of 4.1°C–9.3°C. Minimum HWST was achieved 68 minutes after cryotherapy pack application.ConclusionsDry application of cryotherapy significantly reduced HWST and reached minimums below the therapeutic target of 10°C. This cryotherapy method might offer an effective alternative for digital cooling.

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Temperature variability during targeted temperature management is not associated with neurological outcomes following cardiac arrest

Cited by 10 publications

References 21 publications

Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C

Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C

Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis

Novel dry cryotherapy system for cooling the equine digit

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