Affiliation:
1. Department of Emergency Care and Services University of Helsinki and Helsinki University Hospital Helsinki Finland
2. University of Eastern Finland and Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
3. University of Eastern Finland and Centre of Prehospital Emergency Care Kuopio University Hospital Kuopio Finland
4. Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
5. Department of Neurology Helsinki University Hospital and University of Helsinki Helsinki Finland
Abstract
AbstractBackgroundFever after cardiac arrest may impact outcome. We aimed to assess the incidence of fever in post‐cardiac arrest patients, factors predicting fever and its association with functional outcome in patients treated without targeted temperature management (TTM).MethodsThe FINNRESUSCI observational cohort study in 2010–2011 included intensive care unit (ICU)‐treated out‐of‐hospital cardiac arrest (OHCA) patients from all five Finnish university hospitals and 14 of 15 central hospitals. This post hoc analysis included those FINNRESUSCI study patients who were not treated with TH. We defined fever as at least one temperature measurement of ≥37.8°C within 72 h of ICU admission. The primary outcome was favourable functional outcome at 12 months, defined as cerebral performance category (CPC) of 1 or 2. Binary logistic regression models including witnessed arrest, bystander cardiopulmonary resuscitation (CPR), initial rhythm and delay of return of spontaneous circulation were used to compare the functional outcomes of the groups.ResultsThere were 67,428 temperature measurements from 192 patients, of whom 89 (46%) experienced fever. Twelve‐month CPC was missing in 7 patients, and 51 (28%) patients had favourable functional outcome at 12 months. The patients with shockable initial rhythms had a lower incidence of fever within 72 h of ICU admission (28% vs. 72%, p < .01), and the patients who experienced fever had a longer median return of spontaneous circulation (ROSC) delay (20 [IQR 10–30] vs. 14 [IQR 9–22] min, p < .01). Only initial non‐shockable rhythm (OR 2.99, 95% CI 1.51–5.94) was associated with increased risk of fever within the first 72 h of ICU admission. Neither time in minutes nor area (minutes degree celsius over threshold) over 37°C, 37.5°C, 38°C, 38.5°C, 39°C, 39.5°C or 40°C were significantly different in those with favourable functional outcome compared to those with unfavourable functional outcome within the first 24, 48 or 72 h from ICU admission. Fever was not associated with favourable functional outcome at 12 months (OR 0.90, 95% CI 0.44–1.84).ConclusionsHalf of OHCA patients not treated with TTM developed fever. We found no association between fever and outcome.
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