Changes in cardiac arrest patients’ temperature management after the publication of 2015 AHA guidelines for resuscitation in China

Du, Liqing; Ge, Bao-lan; Ma, Qingbian; Yang, Ji Seung; Chen, Fengying; Mi, Yuhong; Zhu, Huadong; Wang, Cong; Li, Yan; Yang, Rong; Guan, Jian; Zhang, Yixiong; Gao, Jin; Zhu, Haiyan; Xiong, Yan; Wang, Guoxing; Zhu, Zhou‐Hao; Zhang, Haiyan; Zhang, Yun; Zhu, Jinmin; Li, Jie; Lan, Chao; Xiong, Hui

doi:10.1038/s41598-017-16044-7

Cited by 7 publications

(3 citation statements)

References 37 publications

(44 reference statements)

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“…Finally, there is an alternative explanation for the current results is clinician bias in selecting the TTM strategy. Several studies have reported that treating physicians are more likely to select TTM at 33°C for patients they believe to have more severe hypoxic insults in order to maximize the protective effects of TTM against brain damage [1,30]. If a clinical judgment was made based on patient severity, the allocation of more severe patients to the TTM group at 33°C would bias our results to favor 36NTFD.…”

Section: Discussionmentioning

confidence: 96%

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Kong

You

Lee

et al. 2021

Preprint

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Background: Targeted temperature management (TTM) at 32ºC–36ºC improves patient outcomes following out-of-hospital cardiac arrest (OHCA). TTM using automated temperature management devices with feedback systems (TFDs) is recommended, but the equipment is often unavailable. This study aimed to investigate therapeutic relations between targeted temperatures and TFDs on the outcomes of OHCA patients with TTM. To the best of our knowledge, this is the first study to identify the optimal targeted temperature in TTM without TFD with regards to neurological outcomes in OHCA patients. Methods: This prospective multicenter study analyzed nontraumatic OHCA registry data between October 2015 and June 2020 from 62 institutions. Patients were classified into four groups based on targeted temperatures and TFD implementation: TTM at 36ºC with TFD (36TFD), TTM at 33ºC with TFD (33TFD), TTM at 36°C without TFD (36NTFD), and TTM at 33°C without TFD (33TNFD). Clinical outcomes were neurological status at discharge. Results: A total of 938 patients were included in the analysis. A significant interaction was found between targeted temperatures and TFD use on neurological outcomes (P=0.032). There was an independent association between the 33NTFD patients with the least favorable neurological outcomes among the four groups after adjustment for covariates. However, no significant differences were observed in neurological outcomes among the 36TFD, 33TFD, and 36NTFD groups after adjusting for covariates. Compared to 33NTFD patients, 36NTFD patients exhibited significantly higher adjusted ORs for favorable neurological status (OR: 4.28, 95% CI: 1.50–12.16, P<0.01). Conclusions: In OHCA patients receiving TTM without TFDs, the adjusted predicted probability of favorable neurological outcomes at hospital discharge was greater for TTM at 36°C than that at 33°C. The 36NTFD group displayed similar therapeutic effect as the TFD groups. This suggests that a TTM of 36°C rather than 33°C is associated with more favorable neurological outcomes if TFDs are unavailable.

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Section: Discussionmentioning

confidence: 96%

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Kong

You

Lee

et al. 2021

Preprint

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“…The number of AEDs per 100,000 residents was lower than that in many developed countries (17.5, 13, and 5 in the developed Chinese cities of Shenzhen, Haikou, and Shanghai, respectively) [ 9 ]. Target temperature management for cardiac arrest patients was still in the early stage, and only 7.8% of physicians and 5.7% of nurses had implemented therapeutic hypothermia for cardiac arrest patients [ 10 ]. Nevertheless, Chinese emergency physicians have been working hard to improve the prognosis of cardiac arrest patients.…”

Section: Introductionmentioning

confidence: 99%

Monitoring cardiopulmonary resuscitation quality in emergency departments: a national survey in China on current knowledge, attitudes, and practices

Kang

Cao

et al. 2022

BMC Emerg Med

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Background To investigate current knowledge, attitudes, and practices for CPR quality control among emergency physicians in Chinese tertiary hospitals. Methods Anonymous questionnaires were distributed to physicians in 75 tertiary hospitals in China between January and July 2018. Results A total of 1405 respondents answered the survey without obvious logical errors. Only 54.4% respondents knew all criteria of high-quality CPR. A total of 91.0% of respondents considered CPR quality monitoring should be used, 72.4% knew the objective method for monitoring, and 63.2% always/often monitored CPR quality during actual resuscitation. The main problems during CPR were related to chest compression: low quality due to fatigue (67.3%), inappropriate depth (57.3%) and rate (54.1%). The use of recommended monitoring methods was reported as follows, ETCO2 was 42.7%, audio-visual feedback devices was 10.1%, coronary perfusion pressure was 17.9%, and invasive arterial pressure was 31.1%. A total of 96.3% of respondents considered it necessary to participate in regular CPR retraining, but 21.4% did not receive any retraining. The ideal retraining interval was considered to be 3 to 6 months, but the actual interval was 6 to 12 months. Only 49.7% of respondents reported that feedback devices were always/often used in CPR training. Conclusion Chinese emergency physicians were very concerned about CPR quality, but they did not fully understand the high-quality criteria and their impact on prognosis. CPR quality monitoring was not a routine procedure during actual resuscitation. The methods recommended in guidelines were rarely used in practice. Many physicians had not received retraining or received retraining at long intervals. Feedback devices were not commonly used in CPR training.

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“…Recent guidelines have recommended targeted temperature management (TTM) as the neuroprotective intervention in resuscitation care of CA [3,5,6]. Refractory shock inducing recurrent CA or multiorgan failure (MOF) typically results in deaths within the rst 24 hours after return of spontaneous circulation (ROSC), while neurological injury causes later deaths after CA [7].…”

Section: Introductionmentioning

confidence: 99%

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

Kong

Lee

Jeon

et al. 2020

Preprint

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Abstract Background: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be quickly and serially measured without additional effort or costs. This study aimed to investigate whether the serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Methods:We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed the TMA score at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurologic outcome at discharge and 30-day mortality. Results:Increased TMA scores at all measured time points were independent predictors of poor neurologic outcomes and 30-day mortality, with the TMA score at time-12 showing the strongest correlation (OR, 3.008; 95% CI, 1.707–5.3; p=0.001 and HR, 1.517; 95% CI, 1.196–1.925; p=0.001.Specifically, TMA score ≥2 at time-12 was closely associated with increased predictability of poor neurologic outcome (OR, 6.302; 95% CI: 2.841–13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI: 1.675–4.211; p<0.001).Conclusions: Increased TMA scores predicted the neurologic outcome and 30-day mortalityin patients undergoing TTM after OHCA. In addition to the benefit of being quickly and serially measured by using an automated hematology analyzer without additional effort or costs, this finding indicates that the TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with ROSC after OHCA.

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Changes in cardiac arrest patients’ temperature management after the publication of 2015 AHA guidelines for resuscitation in China

Cited by 7 publications

References 37 publications

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Monitoring cardiopulmonary resuscitation quality in emergency departments: a national survey in China on current knowledge, attitudes, and practices

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

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