Doerning Robert, Danielson Kyle R, Hall Jane, Counts Catherine R, Sayre Michael R, Wahlster Sarah, Town James A, Scruggs Sue, Carlbom David J, Johnson Nicholas J
Department of Emergency Medicine, University of Washington, Seattle, WA United States.
Airlift Northwest, UW Medicine, Seattle, WA, United States.
Resusc Plus. 2025 Mar 4;22:100921. doi: 10.1016/j.resplu.2025.100921. eCollection 2025 Mar.
Targeted temperature management (TTM) is commonly used in the setting of out-of-hospital cardiac arrest (OHCA) to improve survival and functional outcomes. However, real-world evidence of effects and optimal temperature are limited. To help address this, we examined associations between TTM and neurologically-intact survival after non-traumatic OHCA across changing institutional TTM temperature goals.
We performed a single-site, retrospective, cohort study of adults with non-traumatic OHCA who arrived comatose to the emergency department and received TTM from 2010 to 2020. Primary exposure was TTM goal temperature. Institutional goal temperature changed from 33 °C (TTM33-1) to 36 °C (TTM36) in 2014 and back to 33 °C (TTM33-2) in 2017. The primary outcome was neurologically-intact survival at discharge, defined as Cerebral Performance Category score of 1 or 2. Secondary outcomes included survival to hospital discharge and care processes. Multivariable logistic regression analysis evaluated association between TTM goal and neurological outcome.
Of 1,469 OCHA patients meeting inclusion criteria, 800 (54%) received TTM. TTM was initiated more frequently during TTM33-1 (60%) than TTM36 (52%) or TTM33-2 (52%). After adjustment for demographic and cardiac arrest characteristics, there was no significant association between TTM goal temperature of 33 °C and neurologically-intact survival, versus 36 °C (adjusted odds ratio 1.10, 95% confidence interval 0.76, 1.60).
TTM goal temperature was not significantly associated with neurologically-intact survival of adult OHCA patients who arrived comatose to the emergency department.
目标温度管理（TTM）常用于院外心脏骤停（OHCA）的救治，以提高生存率和功能预后。然而，关于其效果及最佳温度的实际证据有限。为解决这一问题，我们研究了在不同机构TTM温度目标下，非创伤性OHCA后TTM与神经功能完好存活之间的关联。
我们对2010年至2020年期间昏迷状态下抵达急诊科并接受TTM的非创伤性OHCA成年患者进行了单中心、回顾性队列研究。主要暴露因素为TTM目标温度。机构目标温度在2014年从33°C（TTM33 - 1）变为36°C（TTM36），并在2017年又变回33°C（TTM33 - 2）。主要结局是出院时神经功能完好存活，定义为脑功能分类评分为1或2。次要结局包括出院生存率和护理过程。多变量逻辑回归分析评估TTM目标与神经学结局之间的关联。
在1469例符合纳入标准的OCHA患者中，800例（54%）接受了TTM。在TTM33 - 1期间启动TTM的频率（60%）高于TTM36（52%）或TTM33 - 2（52%）。在调整人口统计学和心脏骤停特征后，33°C的TTM目标温度与神经功能完好存活之间，与36°C相比，无显著关联（调整后的优势比为1.10，95%置信区间为0.76，1.60）。
对于昏迷状态下抵达急诊科的成年OHCA患者，TTM目标温度与神经功能完好存活无显著关联。
