Short Report
Target temperature in post-arrest comatous patients. Is something changed un the postpandemic age?
https://doi.org/10.21203/rs.3.rs-2451539/v1
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We have analyzed the results of our patients, comparing the discharge status of 79 patients with a target temperature of 33°C with 24 patients with a target temperature of 36.5°C . There were no cases of positive Covid-19 in our series. There was an adverse outcome (death or vegetative state) more often in the 36.5°C group (74% vs 47% p 0.015). It is possible that the target temperature in comatous patients after cardiac arrest should be revised in our new post-pandemic reality.
Improving the prognosis and neurological outcome of patients who remain in a coma following cardiac arrest is key in the survival chain, and temperature control is a fundamental part of this process. Since 2003, when hypothermia at 32–34°C was recommended, there have been numerous updates from the International Liaison Committee on Resuscitation (ILCOR) and the European Resuscitation Council (ERC) 1. In our coronary unit, we adopted a protocol of hypothermia to 33°C for comatose patients after cardiac arrest beginning in November 2012. Following the publication of TTM2 Study 2, we decided to change the target temperature from 33°C to 36.5°C. The recommendations of the latest guidelines from the European Resuscitation Council (ERC) indicate active control of central temperature below 37.8°C 3, raising the question of further modifying our protocol.
We analyzed the results of our patients, comparing the discharge status of 79 patients with a target temperature of 33°C (group 1) with 24 patients with a target temperature of 36.5°C (group 2). Group 1 received neuromuscular blockade during hypothermia, while group 2 did not. There were no significant differences in age, sex, diabetes, hypertension, tobacco use, hypercholesterolemia, previous heart failure, old myocardial infarction, or ST segment elevation. The initial rhythm was defibrillable in 67% of group 1 and 71% of group 2, and cardiac arrest was witnessed in 93% of group 1 and 96% of group 2. The median time to recovery of the pulse in those with a recorded time was 25 minutes (interquartile range 16–40) in group 1 versus 30 in group 2 (20–40), with no significant differences. There were no cases of positive COVID-19 in our series. There was an adverse outcome (death or vegetative state) in 37 patients in group 1 (47%) compared to 18 in group 2 (74%), Pearson chi-square 5.868, p = 0.015 (Fig. 1).
It is difficult to explain such an unfavorable result for group 2, which is very similar to group 1, and both groups are also similar to those described in the TTM2 study. The results of group 1, on the other hand, are similar to those of the TTM2 study. All patients in the TTM2 study were recruited prior to the COVID-19 pandemic 2. We can hypothesize that there could be slightly slower attention from the first resuscitation maneuvers due to delays related to protective anti-COVID measures or biological alterations related to recent COVID-19 infection or vaccination. Our data suggest that it is necessary and urgent to analyze the results of changes in the target temperature in centers that care for comatose patients after cardiac arrest. We decided to return to our previous target temperature of 33ºC until further investigation. It is possible that the results of the TTM2 study should be reviewed in our new postpandemic reality.
The need for consent was waived by the approving ethics committee of the University Hospital Virgen Macarena is "CEI de los Hospitales Universitarios Virgen Macarena y Virgen del Rocío
On behalf of all authors, the corresponding author states that there is no conflict of interest. All appropriate ethical guidelines for the use of human subjects have been followed, and we have obtained approval from the ethics committee of the University Hospital Virgen Macarena.
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