Targeted Temperature Management at 33 Versus 36 Degrees: A Retrospective Cohort Study

Crit Care Med. 2020 Mar;48(3):362-369. doi: 10.1097/CCM.0000000000004159.


Objectives: To determine the association between targeted temperature management goal temperature of 33°C versus 36°C and neurologic outcome after out-of-hospital cardiac arrest.

Design: This was a retrospective, before-and-after, cohort study.

Setting: Urban, academic, level 1 trauma center from 2010 to 2017.

Patients: Adults with nontraumatic out-of-hospital cardiac arrest who received targeted temperature management.

Interventions: Our primary exposure was targeted temperature management goal temperature, which was changed from 33°C to 36°C in April of 2014 at the study hospital. Primary outcome was neurologically intact survival to discharge. Secondary outcomes included hospital mortality and care processes.

Measurements and main results: Of 782 out-of-hospital cardiac arrest patients transported to the study hospital, 453 (58%) received targeted temperature management. Of these, 258 (57%) were treated during the 33°C period (targeted temperature management 33°C) and 195 (43%) were treated during the 36°C period (targeted temperature management 36°C). Patients treated during targeted temperature management 33°C were older (57 vs 52 yr; p < 0.05) and had more arrests of cardiac etiology (45% vs 35%; p < 0.05), but otherwise had similar baseline characteristics, including initial cardiac rhythm. A total of 40% of patients treated during targeted temperature management 33°C survived with favorable neurologic outcome, compared with 30% in the targeted temperature management 36°C group (p < 0.05). After adjustment for demographic and cardiac arrest characteristics, targeted temperature management 33°C was associated with increased odds of neurologically intact survival to discharge (odds ratio, 1.79; 95% CI, 1.09-2.94). Targeted temperature management 33°C was not associated with significantly improved hospital mortality. Targeted temperature management was implemented faster (1.9 vs 3.5 hr from 911 call; p < 0.001) and more frequently in the emergency department during the targeted temperature management 33°C period (87% vs 55%; p < 0.001).

Conclusions: Comatose, adult out-of-hospital cardiac arrest patients treated during the targeted temperature management 33°C period had higher odds of neurologically intact survival to hospital discharge compared with those treated during the targeted temperature management 36°C period. There was no significant difference in hospital mortality.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Body Temperature
  • Coma / etiology*
  • Coma / mortality
  • Coma / therapy*
  • Female
  • Hospital Mortality / trends
  • Humans
  • Hypothermia, Induced / methods*
  • Hypothermia, Induced / mortality
  • Male
  • 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
  • Patient Discharge
  • Retrospective Studies
  • Socioeconomic Factors
  • Trauma Centers / statistics & numerical data*