Outcomes of mild-to-moderate postresuscitation shock after non-shockable cardiac arrest and association with temperature management: a post hoc analysis of HYPERION trial data

Abstract

Background Outcomes of postresuscitation shock after cardiac arrest can be affected by targeted temperature management (TTM). A post hoc analysis of the “TTM1 trial” suggested higher mortality with hypothermia at 33 °C. We performed a post hoc analysis of HYPERION trial data to assess potential associations linking postresuscitation shock after non-shockable cardiac arrest to hypothermia at 33 °C on favourable functional outcome. Methods We divided the patients into groups with vs. without postresuscitation (defined as the need for vasoactive drugs) shock then assessed the proportion of patients with a favourable functional outcome (day-90 Cerebral Performance Category [CPC] 1 or 2) after hypothermia (33 °C) vs. controlled normothermia (37 °C) in each group. Patients with norepinephrine or epinephrine > 1 µg/kg/min were not included. Results Of the 581 patients included in 25 ICUs in France and who did not withdraw consent, 339 had a postresuscitation shock and 242 did not. In the postresuscitation-shock group, 159 received hypothermia, including 14 with a day-90 CPC of 1–2, and 180 normothermia, including 10 with a day-90 CPC of 1–2 (8.81% vs. 5.56%, respectively; P = 0.24). After adjustment, the proportion of patients with CPC 1–2 also did not differ significantly between the hypothermia and normothermia groups (adjusted hazards ratio, 1.99; 95% confidence interval, 0.72–5.50; P = 0.18). Day-90 mortality was comparable in these two groups (83% vs. 86%, respectively; P = 0.43). Conclusions After non-shockable cardiac arrest, mild-to-moderate postresuscitation shock at intensive-care-unit admission did not seem associated with day-90 functional outcome or survival. Therapeutic hypothermia at 33 °C was not associated with worse outcomes compared to controlled normothermia in patients with postresuscitation shock. Trial registration ClinicalTrials.gov, NCT01994772

Cumulative dose of epinephrine and mode of death after non-shockable out-of-hospital cardiac arrest: a registry-based study

“…For example, hypothermia at 33 °C was responsible for more arrhythmias resulting in hemodynamic compromise [ 35 ], while the optimal target for TTM in non-shockable rhythm OHCA is still under debate [ 7 , 35 , 36 ], as are blood pressure targets [ 37 , 38 ]. In mild-to-moderate PRS, hypothermia at 33 °C does not seem to impact mortality [ 39 , 40 ], but in the case of severe PRS leading to death, no data are available. Optimization of hemodynamics with a high blood pressure target and a TTM at 36 °C could be considered in subjects at risk of early death from cardiocirculatory causes after a non-shockable OHCA.…”

Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study

“…The following variables were collected: baseline clinical data and comorbidities; characteristics of cardiac arrest and resuscitation; clinical and biological characteristics at ICU admission; treatments delivered in the ICU; length of stay (LOS) in ICU; invasive mechanical ventilation duration; functional and vital status at ICU discharge; and functional and vital status at hospital discharge. Post-resuscitation shock (PRS) was recorded at ICU admission and was defined as a systolic blood pressure below 90 mm Hg for at least 30 min with impaired end-organ perfusion (cool extremities, mottling, or urine output < 30 mL/h), requiring norepinephrine and/or epinephrine intravenous infusion [ 18 ]. The last neurological evaluation was performed on day 90 using the modified Rankin scale [ 19 ].…”