Target temperature management and post-extracorporeal cardiopulmonary resuscitation outcome: A post hoc analysis of the SAVE-J II Study

Abstract

AbstractBackgroundThe conflicting results of previous analyses about hypothermia management in patients with out-of-hospital cardiopulmonary arrest have hindered the establishment of a uniform standard temperature setting for temperature control. This study investigated and compared the clinical outcomes of hypothermic (target temperature: 32–34°C) and normothermic (35–36°C) management of out-of-hospital cardiac arrest (OHCA) patients, treated with extracorporeal cardiopulmonary resuscitation (ECPR).MethodsThis secondary analysis of the SAVE-J II study, a retrospective, multicenter, registry study involving 36 participating institutions in Japan, was undertaken, and ECPR patients with a suspected cardiac etiology were included in this cohort. The primary outcome was survival at hospital discharge. Favorable neurological outcomes (5-point Glasgow-Pittsburgh Cerebral Performance Categories 1–2) constituted the secondary outcome. Multivariable logistic analysis, which was adjusted for potential confounders, was performed for the primary and secondary outcomes.ResultsOf the 949 participants of this study, 57% underwent hypothermic management. A total favorable neurological outcome at hospital discharge was identified in 164 patients (17%), and the survival rate was 35%. In multivariable analysis, with the primary and secondary endpoints as each dependent variable, and gender, age, witness, bystander CPR, electrocardiogram, low flow time, and causative disease as categorical covariates, hypothermic management compared to normothermic management in OHCA patients treated with ECPR, was not significantly associated with a favorable neurological outcome (adjusted odds ratio (aOR): 1.22: 95% CI: 0.85–1.74), but was associated with survival (aOR: 1.74: 95% CI: 1.31–2.32).ConclusionsCompared to normothermic management, hypothermic management of OHCA patients treated with ECPR was not significantly associated with a favorable neurological outcome, but was associated with survival at hospital discharge.