Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm: A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial

Eva M. Spoormans, Jorrit S. Lemkes*, Gladys N. Janssens, Nina W. van der Hoeven, Lucia S. D. Jewbali, Eric A. Dubois, Martijn Meuwissen, Tom A. Rijpstra, Hans A. Bosker, Michiel J. Blans, Gabe B. Bleeker, Remon Baak, Georgios J. Vlachojannis, Bob J. W. Eikemans, Armand R. J. Girbes, Pim van der Harst, Iwan C. C. van der Horst, Michiel Voskuil, Joris J. van der Heijden, Albertus BeishuizenMartin Stoel, Cyril Camaro, Hans van der Hoeven, Jose P. Henriques, Alexander P. J. Vlaar, Maarten A. Vink, Bas van den Bogaard, Ton A. C. M. Heestermans, Wouter de Ruijter, Thijs S. R. Delnoij, Harry J. G. M. Crijns, Gillian A. J. Jessurun, Pranobe Oemrawsingh, Marcel T. M. Gosselink, Koos Plomp, Michael Magro, Peter M. van de Ven, Niels van Royen, Paul W. G. Elbers

*Corresponding author for this work

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OBJECTIVES: The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32 degrees C and 36 degrees C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm. DESIGN: Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial. SETTING: Nineteen hospitals in The Netherlands. PATIENTS: The Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0-34.0 degrees C) or targeted normothermia (36.0-37.0 degrees C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 [95% CI, 0.62-1.18]; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45-1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d [3-7 d] vs 3 d [2-5 d]; ratio of geometric means, 1.32; 95% CI, 1.15-1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups. CONCLUSIONS: In the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.

Original languageEnglish
Pages (from-to)E129-E142
Number of pages14
JournalCritical Care Medicine
Issue number2
Publication statusPublished - Feb-2022


  • cardiac arrest
  • shockable rhythm
  • targeted temperature management
  • 36-DEGREES-C
  • 33-DEGREES-C
  • CARE

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