The influence of post-rewarming temperature management on post-rewarming fever development after cardiac arrest

Early Post-Rewarming Fever Is Associated with Favorable 6-Month Neurologic Outcomes in Patients with Out-Of-Hospital Cardiac Arrest: A Multicenter Registry Study

“…A multicenter observational study using the Penn Alliance for Therapeutic Hypothermia Registry reported that PRF was not associated with survival and neurologic outcomes in OHCA survivors, even though, the higher maximum temperature (≥ 38.8 °C) was associated with worse outcomes in OHCA patients [ 24 ]. Contrary to these prior studies, one retrospective observational study found that elevated temperature within 48 h after TTM was associated with favorable neurologic outcomes regardless of the control of PRF [ 19 ]. In this study, the first (35.3–36.2 °C) or second (36.2–36.5 °C) quartile was independently associated with unfavorable neurologic outcomes compared with the highest quartile (36.8–37.6°C) [ 19 ].…”

“…Contrary to these prior studies, one retrospective observational study found that elevated temperature within 48 h after TTM was associated with favorable neurologic outcomes regardless of the control of PRF [ 19 ]. In this study, the first (35.3–36.2 °C) or second (36.2–36.5 °C) quartile was independently associated with unfavorable neurologic outcomes compared with the highest quartile (36.8–37.6°C) [ 19 ]. Therefore, mild pyrexia following TTM may be an indicator of favorable outcomes in cardiac arrest survivors.…”

“…An observational study showed that the TH group had delayed fever compared to the non-TH group (15 h vs. 36 h) [ 18 ]. Another study that investigated the effects of post-rewarming temperature management (PRTM) that continued additional 24 h to maintain the core temperature as 36 °C with or without PRF demonstrated that PRTM was associated with delayed PRF not with the prevention of PRF [ 19 ]. In the present study, PRTM showed the significant association with lower PRF, but not with the neurologic outcome.…”

“…After TTM became a ubiquitously implemented treatment, it has been also discovered that fever develops even after the completion of TTM [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Although the impact of post-rewarming fever (PRF) that develops after the completion of TTM is inconclusive, experts recommend controlling the PRF [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. PRF above 38.5 °C [ 11 , 12 ] or marked hyperthermia over 38.7 °C [ 13 ] was associated with worse outcomes, and guideline recommended that it is reasonable to actively prevent fever in comatose patients after TTM [ 10 ].…”

“…PRF above 38.5 °C [ 11 , 12 ] or marked hyperthermia over 38.7 °C [ 13 ] was associated with worse outcomes, and guideline recommended that it is reasonable to actively prevent fever in comatose patients after TTM [ 10 ]. However, several studies failed to show the association between PRF and prognosis [ 14 , 15 , 16 , 17 , 18 ], whereas one observational study found that PRF within 48 h after TTM was associated with favorable neurologic outcomes [ 19 ]. Previous studies have analyzed mixed cohorts of OHCA and in-hospital cardiac arrest (IHCA) [ 13 ], included single-center populations [ 11 , 14 , 15 , 16 , 17 ], or used short-term clinical outcomes [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”