The association of different target temperatures in targeted temperature management with neurological outcome after out-of-hospital cardiac arrest based on a prospective multicenter observational study in Korea (the KORHN-PRO registry): IPTW analysis

Abstract

Background Among comatose survivors of out-of-hospital cardiac arrest (OHCA), targeted temperature management (TTM) has improved neurological outcomes. However, although the target temperature shifted from 33°C to 33°C~36°C, the optimal target temperature is still unclear. The goal of this study was to evaluate neurological outcomes at 6 months at target temperatures of 33°C and 36°C. Materials and methods We analyzed OHCA survivors who underwent TTM and were recorded in the Korean Hypothermia Network, a prospective multicenter registry, from October 2015 to December 2018. The primary outcome was good neurological outcome at six months, defined as a cerebral performance category of 1–2, and the secondary outcome was survival at 6 months. Results A total of 1339 patients were treated with TTM in twenty-two emergency departments. Of those, 1054 were treated at 33°C, and 285 were treated at 36°C. There was no significant difference in good neurological outcomes at 6 months (30.6% vs. 31.2%, p = 0.850, adjusted OR 0.97, 95% CI = 0.73–1.29]) and survival at six months (41.4% vs. 38.7%, p = 0.401, adjusted HR 1.08, 95% CI = 0.91–1.28]) between TTM 33°C and TTM 36°C. After propensity score matching, good neurological outcomes at 6 months (OR 0.93, 95% CI = 0.74–1.18) and survival at 6 months (HR 1.05, 95% CI = 0.92–1.21) were still not associated with TTM 33°C and TTM 36°C. Conclusion In this study, patients treated with a target temperature of 33°C had similar good neurological outcomes and survival at six months compared with those treated with a target temperature of 36°C.

Evaluation of the genetic architecture of human blood metabolites on sudden cardiac arrest: A Mendelian randomization analysis

“…Due to the acute onset and narrow treatment window of SCA, it is nearly impossible to identify risk factors through randomized controlled trials or retrospective observational studies. Currently, blood neuron-speci c enolase (NSE), spectrin breakdown products (SBDP), neuro lament heavy chain (Nf-H), red cell distribution width (RDW) [6][7][8] and other clinical biomarkers are employed for severity prognosis.…”