The effect of targeted temperature management on QT and corrected QT intervals in patients with cardiac arrest

Rosol, Z; Miranda, David; Sandoval, Yader; Bart, Bradley A.; Smith, Stephen W.; Goldsmith, Steven R.

doi:10.1016/j.jcrc.2017.02.030

Cited by 18 publications

(15 citation statements)

References 10 publications

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“…In addition, sedatives (e.g., lorazepam) and analgesics (e.g., fentanyl) are used for ensuring adequate sedation and comfort. All patients treated with TTM are monitored on telemetry and have periodic 12-lead electrocardiograms due the risk of QT prolongation with hypothermia [47] and possible heightened risk of VT/VF [48].…”

Section: Practical Considerationsmentioning

confidence: 99%

Targeted Temperature Management for Treatment of Cardiac Arrest

Rasmussen

Bullis

Girotra

2020

Curr Treat Options Cardio Med

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Section: Practical Considerationsmentioning

confidence: 99%

Targeted Temperature Management for Treatment of Cardiac Arrest

Rasmussen

Bullis

Girotra

2020

Curr Treat Options Cardio Med

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“…Although not analyzed in our study, prior literature has shown that electrolyte disturbances and medications are known to prolong ECG intervals in non‐hypothermic states. Rosol et al 9 mentioned that there was no difference in QTc intervals in patients with electrolyte imbalances and/or QT‐prolonging medications compared to those without in their study. There was also not a significant difference in those who developed arrhythmias.…”

Section: Discussionmentioning

confidence: 79%

“…Gachoka et al 15 reported none of 55 patients undergoing targeted temperature management developed Torsades de pointes or ventricular tachycardia. Ulmenstein et al 8 reported 13.7% of 95 patients had ventricular tachycardia and ventricular fibrillation, and Rosol et al, 9 the largest study to date, reported 11.3% of 193 patients developed ventricular tachycardia, ventricular fibrillation, or Torsades de pointes. Both latter studies showed no statistical difference in QT or QTc interval between those with and without ventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison to our study, of the few patients who developed dysrhythmias, none were clinically significant (Table 2). Potentially as incongruent with other studies, we did not use continuous telemetry monitoring to determine if a clinically significant, albeit transient, dysrhythmias were present 9,12,15 . It is presumed, however, that if a patient had even a transient arrhythmia, it would be documented on the chart.…”

Section: Discussionmentioning

confidence: 99%

“…These arrhythmias are hypothesized to be due to serum electrolyte changes, including an increase in intracellular calcium, combined with myocardial repolarization variability that occurs with hypothermia 8 . Multiple case reports and studies demonstrate that hypothermia is associated with a significant prolongation in QT and QTc interval 9,10 …”

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic changes in patients undergoing targeted temperature management

et al. 2020

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Objectives Targeted temperature management is the recommended therapy for comatose patients after an out‐of‐hospital cardiac arrest resuscitation due to the reduction in neurological damage and improved outcomes. However, there may result in electrocardiographic instability depending on the degree of targeted temperature management, including minor or life‐threatening dysrhythmias or conduction delays. This project aims to describe the frequency of ECG interval changes and clinically relevant dysrhythmias in targeted temperature management patients. Methods This is a retrospective observational study from January 2009 to December 2015. Patients who qualified for the study had a non‐traumatic cardiac arrest with a return of spontaneous circulation, received targeted temperature management at 33.5°C for 24 hours followed by 16 hours of rewarming. ECG interval changes and dysrhythmias were recorded immediately after return of spontaneous circulation, and at 24 and 48 hours post return of spontaneous circulation. Results A total of 322 patients (age 61.0 ± 16.9 years) had targeted temperature management initiated during the study period, of which 169 had complete data and 13 died prior to completing 24 hours of hypothermia. There were statistically significant changes during targeted temperature management in heart rate (96.7 ± 26.0/min before targeted temperature management; 69.5 ± 19.1/min during, P < 0.001), QRS duration (115.1 ± 32.6 ms before targeted temperature management; 107.8 ± 27.9 ms during targeted temperature management, P < 0.001), and QTc (486.3 ± 52.8 ms before targeted temperature management; 526.9 ± 61.7 ms during targeted temperature management, P < 0.001). There were cardiac dysrhythmias that received treatment during cooling and rewarming. Conclusion During the period of targeted temperature management and rewarming, we observed few self‐limiting ECG interval changes and no clinically significant dysrhythmias in this population during the period of targeted temperature management.

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Hypothermieinduzierte EKG-Veränderungen: charakteristisch, aber nicht spezifisch

Michels

Ney

Hoffmann

et al. 2017

Med Klin Intensivmed Notfmed

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Hypothermia-induced J‑ or so-called Osborn waves can be detected under therapeutic hypothermia in approximately 20-40% of cases. The occurrence of J‑waves in the context of the targeted temperature management after cardiopulmonary resuscitation is characteristic, but not pathognomonic for hypothermia. An electrocardiographic diagnosis under hypothermia after cardiac arrest should always be done with caution due to the various hypothermia-associated electromechanical changes of the myocardium.

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The effect of targeted temperature management on QT and corrected QT intervals in patients with cardiac arrest

Cited by 18 publications

References 10 publications

Targeted Temperature Management for Treatment of Cardiac Arrest

Targeted Temperature Management for Treatment of Cardiac Arrest

Electrocardiographic changes in patients undergoing targeted temperature management

Hypothermieinduzierte EKG-Veränderungen: charakteristisch, aber nicht spezifisch

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