Effects of targeted temperature management at 33°C vs. 36°C on comatose patients after cardiac arrest stratified by the severity of encephalopathy

Sjoukje Nutma; Marleen C Tjepkema-Cloostermans; Barry J Ruijter; Selma C Tromp; Walter M van den Bergh; Norbert A Foudraine; Francois H M Kornips; Gea Drost; Erik Scholten; Aart Strang; Albertus Beishuizen; Michel J A M van Putten; Jeannette Hofmeijer

doi:10.1016/j.resuscitation.2022.01.026

Effects of targeted temperature management at 33°C vs. 36°C on comatose patients after cardiac arrest stratified by the severity of encephalopathy

Sjoukje Nutma^*, Marleen C Tjepkema-Cloostermans, Barry J Ruijter, Selma C Tromp, Walter M van den Bergh, Norbert A Foudraine, Francois H M Kornips, Gea Drost, Erik Scholten, Aart Strang, Albertus Beishuizen, Michel J A M van Putten, Jeannette Hofmeijer

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVES: To assess neurological outcome after targeted temperature management (TTM) at 33°C vs. 36°C, stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h.

DESIGN: Post hoc analysis of prospective cohort study.

SETTING: Five Dutch Intensive Care units.

PATIENTS: 479 adult comatose post-cardiac arrest patients.

INTERVENTIONS: TTM at 33°C (n=270) or 36°C (n=209) and continuous EEG monitoring.

MEASUREMENTS AND MAIN RESULTS: Outcome according to the cerebral performance category (CPC) score at 6 months post-cardiac arrest was similar after 33°C and 36°C. However, when stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h after cardiac arrest, the proportion of good outcome (CPC 1-2) in patients with moderate encephalopathy was significantly larger after TTM at 33°C (66% vs. 45%; Odds Ratios 2.38, 95% CI=1.32-4.30; p=0.004). In contrast, with mild encephalopathy, there was no statistically significant difference in the proportion of patients with good outcome between 33°C and 36°C (88% vs. 81%; OR 1.68, 95% CI=0.65-4.38; p=0.282). Ordinal regression analysis showed a shift towards higher CPC scores when treated with TTM 33°C as compared with 36°C in moderate encephalopathy (cOR 2.39; 95% CI=1.40-4.08; p=0.001), but not in mild encephalopathy (cOR 0.81 95% CI=0.41-1.59; p=0.537). Adjustment for initial cardiac rhythm and cause of arrest did not change this relationship.

CONCLUSIONS: Effects of TTM probably depend on the severity of encephalopathy in comatose patients after cardiac arrest. These results support inclusion of predefined subgroup analyses based on EEG measures of the severity of encephalopathy in future clinical trials.

Original language	English
Pages (from-to)	147-153
Number of pages	7
Journal	Resuscitation
Volume	173
Early online date	2-Feb-2022
DOIs	https://doi.org/10.1016/j.resuscitation.2022.01.026
Publication status	Published - Apr-2022

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Effects of targeted temperature management at 33 °C vs. 36 °C on comatose patients after cardiac arrest stratified by the severity of encephalopathyFinal publisher's version, 616 KBLicence: Taverne

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Nutma, S., Tjepkema-Cloostermans, M. C., Ruijter, B. J., Tromp, S. C., van den Bergh, W. M., Foudraine, N. A., H M Kornips, F., Drost, G., Scholten, E., Strang, A., Beishuizen, A., J A M van Putten, M., & Hofmeijer, J. (2022). Effects of targeted temperature management at 33°C vs. 36°C on comatose patients after cardiac arrest stratified by the severity of encephalopathy. Resuscitation, 173, 147-153. https://doi.org/10.1016/j.resuscitation.2022.01.026

@article{e5759063f68e4e45b34b28a4e44f5256,

title = "Effects of targeted temperature management at 33°C vs. 36°C on comatose patients after cardiac arrest stratified by the severity of encephalopathy",

abstract = "OBJECTIVES: To assess neurological outcome after targeted temperature management (TTM) at 33°C vs. 36°C, stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h.DESIGN: Post hoc analysis of prospective cohort study.SETTING: Five Dutch Intensive Care units.PATIENTS: 479 adult comatose post-cardiac arrest patients.INTERVENTIONS: TTM at 33°C (n=270) or 36°C (n=209) and continuous EEG monitoring.MEASUREMENTS AND MAIN RESULTS: Outcome according to the cerebral performance category (CPC) score at 6 months post-cardiac arrest was similar after 33°C and 36°C. However, when stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h after cardiac arrest, the proportion of good outcome (CPC 1-2) in patients with moderate encephalopathy was significantly larger after TTM at 33°C (66% vs. 45%; Odds Ratios 2.38, 95% CI=1.32-4.30; p=0.004). In contrast, with mild encephalopathy, there was no statistically significant difference in the proportion of patients with good outcome between 33°C and 36°C (88% vs. 81%; OR 1.68, 95% CI=0.65-4.38; p=0.282). Ordinal regression analysis showed a shift towards higher CPC scores when treated with TTM 33°C as compared with 36°C in moderate encephalopathy (cOR 2.39; 95% CI=1.40-4.08; p=0.001), but not in mild encephalopathy (cOR 0.81 95% CI=0.41-1.59; p=0.537). Adjustment for initial cardiac rhythm and cause of arrest did not change this relationship.CONCLUSIONS: Effects of TTM probably depend on the severity of encephalopathy in comatose patients after cardiac arrest. These results support inclusion of predefined subgroup analyses based on EEG measures of the severity of encephalopathy in future clinical trials.",

author = "Sjoukje Nutma and Tjepkema-Cloostermans, {Marleen C} and Ruijter, {Barry J} and Tromp, {Selma C} and {van den Bergh}, {Walter M} and Foudraine, {Norbert A} and {H M Kornips}, Francois and Gea Drost and Erik Scholten and Aart Strang and Albertus Beishuizen and {J A M van Putten}, Michel and Jeannette Hofmeijer",

year = "2022",

month = apr,

doi = "10.1016/j.resuscitation.2022.01.026",

language = "English",

volume = "173",

pages = "147--153",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "ELSEVIER IRELAND LTD",

}

Nutma, S, Tjepkema-Cloostermans, MC, Ruijter, BJ, Tromp, SC, van den Bergh, WM, Foudraine, NA, H M Kornips, F, Drost, G, Scholten, E, Strang, A, Beishuizen, A, J A M van Putten, M & Hofmeijer, J 2022, 'Effects of targeted temperature management at 33°C vs. 36°C on comatose patients after cardiac arrest stratified by the severity of encephalopathy', Resuscitation, vol. 173, pp. 147-153. https://doi.org/10.1016/j.resuscitation.2022.01.026

TY - JOUR

T1 - Effects of targeted temperature management at 33°C vs. 36°C on comatose patients after cardiac arrest stratified by the severity of encephalopathy

AU - Nutma, Sjoukje

AU - Tjepkema-Cloostermans, Marleen C

AU - Ruijter, Barry J

AU - Tromp, Selma C

AU - van den Bergh, Walter M

AU - Foudraine, Norbert A

AU - H M Kornips, Francois

AU - Drost, Gea

AU - Scholten, Erik

AU - Strang, Aart

AU - Beishuizen, Albertus

AU - J A M van Putten, Michel

AU - Hofmeijer, Jeannette

PY - 2022/4

Y1 - 2022/4

N2 - OBJECTIVES: To assess neurological outcome after targeted temperature management (TTM) at 33°C vs. 36°C, stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h.DESIGN: Post hoc analysis of prospective cohort study.SETTING: Five Dutch Intensive Care units.PATIENTS: 479 adult comatose post-cardiac arrest patients.INTERVENTIONS: TTM at 33°C (n=270) or 36°C (n=209) and continuous EEG monitoring.MEASUREMENTS AND MAIN RESULTS: Outcome according to the cerebral performance category (CPC) score at 6 months post-cardiac arrest was similar after 33°C and 36°C. However, when stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h after cardiac arrest, the proportion of good outcome (CPC 1-2) in patients with moderate encephalopathy was significantly larger after TTM at 33°C (66% vs. 45%; Odds Ratios 2.38, 95% CI=1.32-4.30; p=0.004). In contrast, with mild encephalopathy, there was no statistically significant difference in the proportion of patients with good outcome between 33°C and 36°C (88% vs. 81%; OR 1.68, 95% CI=0.65-4.38; p=0.282). Ordinal regression analysis showed a shift towards higher CPC scores when treated with TTM 33°C as compared with 36°C in moderate encephalopathy (cOR 2.39; 95% CI=1.40-4.08; p=0.001), but not in mild encephalopathy (cOR 0.81 95% CI=0.41-1.59; p=0.537). Adjustment for initial cardiac rhythm and cause of arrest did not change this relationship.CONCLUSIONS: Effects of TTM probably depend on the severity of encephalopathy in comatose patients after cardiac arrest. These results support inclusion of predefined subgroup analyses based on EEG measures of the severity of encephalopathy in future clinical trials.

AB - OBJECTIVES: To assess neurological outcome after targeted temperature management (TTM) at 33°C vs. 36°C, stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h.DESIGN: Post hoc analysis of prospective cohort study.SETTING: Five Dutch Intensive Care units.PATIENTS: 479 adult comatose post-cardiac arrest patients.INTERVENTIONS: TTM at 33°C (n=270) or 36°C (n=209) and continuous EEG monitoring.MEASUREMENTS AND MAIN RESULTS: Outcome according to the cerebral performance category (CPC) score at 6 months post-cardiac arrest was similar after 33°C and 36°C. However, when stratified by the severity of encephalopathy based on EEG-patterns at 12 and 24h after cardiac arrest, the proportion of good outcome (CPC 1-2) in patients with moderate encephalopathy was significantly larger after TTM at 33°C (66% vs. 45%; Odds Ratios 2.38, 95% CI=1.32-4.30; p=0.004). In contrast, with mild encephalopathy, there was no statistically significant difference in the proportion of patients with good outcome between 33°C and 36°C (88% vs. 81%; OR 1.68, 95% CI=0.65-4.38; p=0.282). Ordinal regression analysis showed a shift towards higher CPC scores when treated with TTM 33°C as compared with 36°C in moderate encephalopathy (cOR 2.39; 95% CI=1.40-4.08; p=0.001), but not in mild encephalopathy (cOR 0.81 95% CI=0.41-1.59; p=0.537). Adjustment for initial cardiac rhythm and cause of arrest did not change this relationship.CONCLUSIONS: Effects of TTM probably depend on the severity of encephalopathy in comatose patients after cardiac arrest. These results support inclusion of predefined subgroup analyses based on EEG measures of the severity of encephalopathy in future clinical trials.

U2 - 10.1016/j.resuscitation.2022.01.026

DO - 10.1016/j.resuscitation.2022.01.026

M3 - Article

C2 - 35122892

SN - 0300-9572

VL - 173

SP - 147

EP - 153

JO - Resuscitation

JF - Resuscitation

ER -

Effects of targeted temperature management at 33°C vs. 36°C on comatose patients after cardiac arrest stratified by the severity of encephalopathy

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