The precision of target temperature management in comatose survivors of cardiac arrest - a quality assessment

Abstract

Introduction: To mitigate reperfusion cerebral injury secondary to cardiac arrest (CA), postresuscitation target temperature management (TTM) is applied. TTM generally includes 24h of hypothermia followed by controlled normothermia. Objective: To evaluate the precision of TTM at Sahlgrenska University Hospital by assessing potential deviations from protocol quality requirements as well as identifying potential areas of improvement. Method: 2 historical cohorts of 45 patients treated by TTM 2011-2013 and 76 patients treated by TTM 2018-2020 were included. Outcome measures as to precision of TTM were time from return of spontaneous circulation [ROSC] to target temperature, temperature variability during hypothermia (mean absolute deviation [MAD]) and incidence of fever (T≥38.5°C). Comparison between study groups was used to evaluate the change in precision over time and a comparison of the 2018–2020 data to current literature was made to assess the precision compared to international standards. Results: Time from ROSC to target temperature 33°C was significantly shorter in the 2018-‐‑2020 study group (mean 6h38min) than in the 2011-‐‑2013 study group (mean 10h6min). Variability was significantly lower in the 2018-‐‑2020 study group (average MAD [mean absolute deviation] 0.23°C) than in the 2011-‐‑2013 study group (average MAD 0.47°C). Fever incidence during normothermia phase was significantly lower in the 2018-‐2020 study group (11%) than in the 2011-‐‑2013 study group (29%). Conclusion: Overall, precision of TTM at Sahlgrenska University Hospital as to timing, variability and fever incidence had improved over time and was in line with reported data from the largest studies of TTM today.