Functional outcomes associated with varying levels of targeted temperature management after out-of-hospital cardiac arrest - An INTCAR2 registry analysis

Resuscitation. 2020 Jan 1:146:229-236. doi: 10.1016/j.resuscitation.2019.10.020. Epub 2019 Nov 9.


Introduction: Targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) has been recommended in international guidelines since 2005. The TTM-trial published in 2013 showed no difference in survival or neurological outcome for patients randomised to 33 °C or 36 °C, and many hospitals have changed practice. The optimal utilization of TTM is still debated. This study aimed to analyse if a difference in temperature goal was associated with outcome in an unselected international registry population.

Methods: This is a retrospective observational study based on a prospective registry - the International Cardiac Arrest Registry 2. Patients were categorized as receiving TTM in the lower range at 32-34 °C (TTM-low) or at 35-37 °C (TTM-high). Primary outcome was good functional status defined as cerebral performance category (CPC) of 1-2 at hospital discharge and secondary outcome was adverse events related to TTM. A logistic regression model was created to evaluate the independent effect of temperature by correcting for clinical and demographic factors associated with outcome.

Results: Of 1710 patients included, 1242 (72,6%) received TTM-low and 468 (27,4%) TTM-high. In patients receiving TTM-low, 31.3% survived with good outcome compared to 28.8% in the TTM-high group. There was no significant association between temperature and outcome (p = 0.352). In analyses adjusted for baseline differences the OR for a good outcome with TTM-low was 1.27, 95% CI (0.94-1.73). Haemodynamic instability leading to discontinuation of TTM was more common in TTM-low.

Conclusions: No significant difference in functional outcome at hospital discharge was found in patients receiving lower- versus higher targeted temperature management.

Keywords: Cardiac arrest; Out-of-hospital; Outcome; TTM; Targeted temperature management.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Temperature*
  • Cardiopulmonary Resuscitation / adverse effects
  • Cardiopulmonary Resuscitation / methods
  • Cardiopulmonary Resuscitation / statistics & numerical data
  • Female
  • Functional Status*
  • Humans
  • Hypothermia, Induced* / adverse effects
  • Hypothermia, Induced* / methods
  • Hypothermia, Induced* / standards
  • International Cooperation
  • Male
  • Middle Aged
  • Neurologic Examination* / methods
  • Neurologic Examination* / statistics & numerical data
  • Neuroprotection / physiology
  • Out-of-Hospital Cardiac Arrest* / epidemiology
  • Out-of-Hospital Cardiac Arrest* / therapy
  • Outcome and Process Assessment, Health Care
  • Registries / statistics & numerical data
  • Retrospective Studies