Background
Targeted temperature management (
TTM
) is a recommended treatment modality to improve neurological outcomes in patients with out‐of‐hospital cardiac arrest. The impact of the duration from hospital admission to
TTM
initiation (door‐to‐
TTM
;
DTT
) on clinical outcomes has not been well elucidated. We hypothesized that shorter
DTT
initiation intervals would be associated with improved survival with favorable neurological outcome.
Methods and Results
We performed a post hoc analysis of nontraumatic paramedic‐treated out‐of‐hospital cardiac arrests. The primary outcome was favorable neurological status at hospital discharge, with a secondary outcome of survival to discharge. We fit a logistic regression analysis to determine the association of early compared with delayed
DTT
, dichotomized by the median
DTT
duration, and outcomes. Of 3805 patients enrolled in the
CCC
(Continuous Chest Compressions) Trial in British Columbia, 570 were included in this analysis. There was substantial variation in
DTT
among patients receiving
TTM
. The median
DTT
duration was 122 minutes (interquartile range 35‐218). Favorable neurological outcomes in the early and delayed
DTT
groups were 48% and 38%, respectively. Compared with delayed
DTT
(interquartile range 167‐319 minutes), early
DTT
(interquartile range 20‐81 minutes) was associated with survival (adjusted odds ratio 1.56, 95%
CI
1.02‐2.38) but not with favorable neurological outcomes (adjusted odds ratio 1.45, 95%
CI
, 0.94‐2.22) at hospital discharge.
Conclusions
There was wide variability in the initiation of
TTM
among comatose out‐of‐hospital cardiac arrest survivors. Initiation of
TTM
within 122 minutes of hospital admission was associated with improved survival. These results support in‐hospital efforts to achieve early
DTT
among out‐of‐hospital cardiac arrest patients admitted to the hospital.
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