Effectiveness and safety of early enteral nutrition for patients who received targeted temperature management after out-of-hospital cardiac arrest

Resuscitation. 2019 Feb;135:191-196. doi: 10.1016/j.resuscitation.2019.01.007. Epub 2019 Jan 14.

Abstract

Aim: Early enteral nutrition (EN) is recommended for critically ill patients; however, few reports have examined early EN for patients who received targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). We investigated the effectiveness and safety of early EN for patients who received TTM after OHCA.

Methods: We used a nationwide Japanese administrative database to identify OHCA patients who received TTM from April 2008 to March 2017. The primary outcome was 30-day mortality; secondary outcomes were incidences of all-cause infection, pneumonia, and intestinal ischemia.

Results: Of the 1932 OHCA patients who received TTM, 1682 met the inclusion criteria. Of these, 294 received early EN within 2 days from the initiation of TTM and 266 propensity-score matched pairs were generated. Cox regression analyses revealed no significant difference in 30-day mortality between groups (hazard ratio (HR): 0.90; 95% confidence interval (95% CI): 0.65-1.25). There was no significant difference in the incidence of all-cause infection (odds ratio (OR): 0.98; 95% CI: 0.66-1.46) or pneumonia (OR: 1.02; 95% CI: 0.68-1.55). Subgroup analyses of patients with a low body mass index (BMI; kg/m2) (< 18.5) revealed a significant decrease of 30-day mortality in the early EN group (HR: 0.30; 95% CI: 0.092-0.97) but no significant difference among patients with a BMI ≥ 18.5 (HR: 1.01; 95% CI: 0.72-1.43).

Conclusion: Among patients who received TTM after OHCA, there was no significant association between early EN and 30-day mortality; however, early EN could be beneficial for patients with a low BMI.

Keywords: Body mass index; Early enteral nutrition; Malnutrition; Out-of-hospital cardiac arrest; Propensity score matching; Targeted temperature management; Therapeutic hypothermia.

MeSH terms

  • Body Mass Index
  • Cardiopulmonary Resuscitation / adverse effects
  • Cardiopulmonary Resuscitation / methods
  • Databases, Factual / statistics & numerical data
  • Early Medical Intervention / methods
  • Enteral Nutrition / methods*
  • Female
  • Humans
  • Hypothermia, Induced* / adverse effects
  • Hypothermia, Induced* / methods
  • Incidence
  • Japan / epidemiology
  • Male
  • Malnutrition* / diagnosis
  • Malnutrition* / etiology
  • Malnutrition* / prevention & control
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest* / complications
  • Out-of-Hospital Cardiac Arrest* / mortality
  • Out-of-Hospital Cardiac Arrest* / therapy
  • Outcome and Process Assessment, Health Care
  • Risk Factors
  • Time-to-Treatment / standards