Targeted Temperature Management for Treatment of Cardiac Arrest

Rasmussen, Tyler P.; Bullis, Tyler; Girotra, Saket

doi:10.1007/s11936-020-00846-6

Cited by 13 publications

(12 citation statements)

References 55 publications

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“…The overall IHCA survival rates in both LBH (23.5%) and HBH (20.5%) were lower than recently reported across hospitals in the United States (26)(27)(28)(29). We also found a slight decline in the survival trend in both LBH and HBH during the study period in contrast with demonstrated improvement in IHCA survival outcomes over the last 2 decades (23,24,27). Lack of health insurance and underinsurance has been linked to higher in-hospital mortality in cardiac arrest patients (8,30,31).…”

Section: Discussioncontrasting

confidence: 72%

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Olanipekun

Abe

Chris-Olaiya

et al. 2023

Critical Care Explorations

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IMPORTANCE: High safety-net burden hospitals (HBHs) treating large numbers of uninsured or Medicaid-insured patients have generally been linked to worse clinical outcomes. However, limited data exist on the impact of the hospitals’ safety-net burden on in-hospital cardiac arrest (IHCA) outcomes in the United States. OBJECTIVES: To compare the differences in survival to discharge, routine discharge home, and healthcare resource utilization between patients at HBH with those treated at low safety-net burden hospital (LBH). DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study across hospitals in the United States: Hospitalized patients greater than or equal to 18 years that underwent cardiopulmonary resuscitation (CPR) between 2008 and 2018 identified from the Nationwide Inpatient Database. Data analysis was conducted in January 2022. EXPOSURE: IHCA. MAIN OUTCOMES AND MEASURES: The primary outcome is survival to hospital discharge. Other outcomes are routine discharge home among survivors, length of hospital stay, and total hospitalization cost RESULTS: From 2008 to 2018, an estimated 555,016 patients were hospitalized with IHCA, of which 19.2% occurred at LBH and 55.2% at HBH. Compared with LBH, patients at HBH were younger (62 ± 20 yr vs 67 ± 17 yr) and predominantly in the lowest median household income (< 25th percentile). In multivariate analysis, HBH was associated with lower chances of survival to hospital discharge (adjusted odds ratio [aOR], 0.88; 95% CI, 0.85–0.96) and lower odds of routine discharge (aOR, 0.6; 95% CI, 0.47–0.75), compared with LBH. In addition, IHCA patients at publicly owned hospitals and those with medium and large hospital bed size were less likely to survive to hospital discharge, while patients with median household income greater than 25th percentile had better odds of hospital survival. CONCLUSIONS AND RELEVANCE: Our study suggests that patients who experience IHCA at HBH may have lower rates and odds of in-hospital survival and are less likely to be routinely discharged home after CPR. Median household income and hospital-level characteristics appear to contribute to survival.

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Section: Discussioncontrasting

confidence: 72%

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Olanipekun

Abe

Chris-Olaiya

et al. 2023

Critical Care Explorations

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“…2,3 Over the past decade, hospitals have devoted considerable effort toward improving IHCA survival by improving care delivery during the acute resuscitation phase [4][5][6] and the postresuscitation phase. 7 Despite these efforts, IHCA survival rates have plateaued in recent years, with mean survival of approximately 25%. 2,8,9 Given the high incidence and low survival for IHCA, efforts targeted toward prevention of IHCA could be impactful.…”

Section: Introductionmentioning

confidence: 99%

“…In-hospital cardiac arrest (IHCA) affects nearly 290 000 hospitalized patients each year in the United States and is associated with poor survival and a high risk of neurological disability among survivors . Over the past decade, hospitals have devoted considerable effort toward improving IHCA survival by improving care delivery during the acute resuscitation phase and the postresuscitation phase . Despite these efforts, IHCA survival rates have plateaued in recent years, with mean survival of approximately 25% .…”

Section: Introductionmentioning

confidence: 99%

Variation Across Hospitals in In-Hospital Cardiac Arrest Incidence Among Medicare Beneficiaries

Rasmussen

Riley

Sarazin³

et al. 2022

JAMA Netw Open

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IMPORTANCE Although survival for in-hospital cardiac arrest (IHCA) has improved substantially over the last 2 decades, survival rates have plateaued in recent years. A better understanding of hospital differences in IHCA incidence may provide important insights regarding best practices for prevention of IHCA. OBJECTIVETo determine the incidence of IHCA among Medicare beneficiaries, and evaluate hospital variation in incidence of IHCA. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study analyzes 2014 to 2017 data from 170 hospitals participating in the Get With The Guidelines-Resuscitation registry, linked to Medicare files. Participants were adults aged 65 years and older. Statistical analysis was performed from January to December 2021. EXPOSURES Case-mix index, teaching status, and nurse-staffing. MAIN OUTCOMES AND MEASURES Hospital incidence of IHCA among Medicare beneficiaries was estimated as the number of IHCA patients divided by the total number of hospital admissions.Multivariable hierarchical regression models were used to calculate hospital incidence rates adjusted for differences in patient case-mix and evaluate the association of hospital variables with IHCA incidence. RESULTS Among a total of 4.5 million admissions at 170 hospitals, 38 630 patients experienced an IHCA during 2014 to 2017. Among the 38 630 patients with IHCAs, 7571 (19.6%) were non-Hispanic Black, 26 715 (69.2%) were non-Hispanic White, and 16 732 (43.3%) were female; the mean (SD) age at admission was 76.3 (7.8) years. The median risk-adjusted IHCA incidence was 8.5 per 1000 admissions (95% CI, 8.2-9.0 per 1000 admissions). After adjusting for differences in case-mix index, IHCA incidence varied markedly across hospitals ranging from 2.4 per 1000 admissions to 25.5 per 1000 admissions (IQR, median odds ratio, 1.51 [95% CI,). Among hospital variables, a higher case-mix index, higher nurse staffing, and teaching status were associated with a lower hospital incidence of IHCA.CONCLUSIONS AND RELEVANCE This cohort study found that the incidence of IHCA varies markedly across hospitals, and hospitals with higher nurse staffing and teaching status had lower IHCA incidence rates. Future studies are needed to better understand processes of care at hospitals with exceptionally low IHCA incidence to identify best practices for cardiac arrest prevention.

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“…Although the results of these two landmark trials were promising, there were several limitations that dampened the enthusiasm: they were open-label, their sample size the small with a high rate of screen failures (thus, raising concern for non-generalization), and at the time there were no established protocols for neuroprognostication post-CA and withdrawal of life-sustaining therapy (WLST) [ 36 ]. These limitations were subsequently addressed in the 2013 TTM1 trial, a RCT that analyzed 939 adult OHCA patients who remained unresponsive to verbal commands, and randomly assigned them to either temperature control at 33 °C or 36 °C for 24 h, followed by controlled active rewarming at 0.5 °C/h to 37 °C and subsequent normothermia until 72 h from randomization.…”

Section: Methodsmentioning

confidence: 99%

Temperature Control After Cardiac Arrest: A Narrative Review

et al. 2023

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Cardiac arrest (CA) is a critical public health issue affecting more than half a million Americans annually. The main determinant of outcome post-CA is hypoxic-ischemic brain injury (HIBI), and temperature control is currently the only evidence-based, guideline-recommended intervention targeting secondary brain injury. Temperature control is a key component of a post-CA care bundle; however, conflicting evidence challenges its wide implementation across the vastly heterogeneous population of CA survivors. Here, we critically appraise the available literature on temperature control in HIBI, detail how the evidence has been integrated into clinical practice, and highlight the complications associated with its use and the timing of neuroprognostication after CA. Future clinical trials evaluating different temperature targets, rates of rewarming, duration of cooling, and identifying which patient phenotype benefits from different temperature control methods are needed to address these prevailing knowledge gaps.

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Targeted Temperature Management for Treatment of Cardiac Arrest

Cited by 13 publications

References 55 publications

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Variation Across Hospitals in In-Hospital Cardiac Arrest Incidence Among Medicare Beneficiaries

Temperature Control After Cardiac Arrest: A Narrative Review

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