Influence of temperature management at 33 °C versus normothermia on survival in patients with vasopressor support after out-of-hospital cardiac arrest: a post hoc analysis of the TTM-2 trial
Joachim Düring,
Martin Annborn,
Alain Cariou,
Michelle S. Chew,
Josef Dankiewicz,
Hans Friberg,
Matthias Haenggi,
Zana Haxhija,
Janus C. Jakobsen,
Halvor Langeland,
Fabio Silvio Taccone,
Matthew Thomas,
Susann Ullén,
Matt P. Wise,
Niklas Nielsen
Affiliations
Joachim Düring
Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skåne University Hospital
Martin Annborn
Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital
Alain Cariou
Cochin University Hospital (APHP) and University of Paris (Medical School)
Michelle S. Chew
Department of Anesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University
Josef Dankiewicz
Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital
Hans Friberg
Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skåne University Hospital
Matthias Haenggi
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern
Zana Haxhija
Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skåne University Hospital
Janus C. Jakobsen
Copenhagen Trial Unit, Centre for Clinical Intervention Research
Halvor Langeland
Department of Anesthesiology and Intensive Care Medicine, St. Olav’s University Hospital
Fabio Silvio Taccone
Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles
Matthew Thomas
Department of Intensive Care, University Hospitals Bristol and Weston
Susann Ullén
Clinical Studies Sweden- Forum South, Skåne University Hospital
Matt P. Wise
Adult Critical Care, University Hospital of Wales
Niklas Nielsen
Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital
Abstract Background Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA. Methods We performed a post hoc analysis of patients included in the TTM-2 trial, an international, multicenter trial, investigating outcomes in unconscious adult OHCA patients randomized to TTM33 versus normothermia. Patients were grouped according to level of circulatory support on admission: (1) no-vasopressor support, mean arterial blood pressure (MAP) ≥ 70 mmHg; (2) moderate-vasopressor support MAP 0.25 µg/kg/min. Hazard ratios with TTM33 were calculated for all-cause 180-day mortality in these groups. Results The TTM-2 trial enrolled 1900 patients. Data on primary outcome were available for 1850 patients, with 662, 896, and 292 patients in the, no-, moderate-, or high-vasopressor support groups, respectively. Hazard ratio for 180-day mortality was 1.04 [98.3% CI 0.78–1.39] in the no-, 1.22 [98.3% CI 0.97–1.53] in the moderate-, and 0.97 [98.3% CI 0.68–1.38] in the high-vasopressor support groups with regard to TTM33. Results were consistent in an imputed, adjusted sensitivity analysis. Conclusions In this exploratory analysis, temperature control at 33 °C after OHCA, compared to normothermia, was not associated with higher incidence of death in patients stratified according to vasopressor support on admission. Trial registration Clinical trials identifier NCT02908308 , registered September 20, 2016.
