Temperature Control Parameters Are Important: Earlier Preinduction Is Associated With Improved Outcomes Following Out-of-Hospital Cardiac Arrest - 19/07/24
, Noah Kim, BS a, b, Christine Nguyen, BS a, George McGinniss, MD c, Yanhong Deng, MPH d, Eva Kitlen, BS a, e, Gabriella Garcia, MD a, f, Charles Wira, MD c, Akhil Khosla, MD g, Jennifer Johnson, MSN, APRN h, P. Elliott Miller, MD i, Sarah M. Perman, MD, MSCE c, Kevin N. Sheth, MD a, David M. Greer, MD, MA j, Emily J. Gilmore, MD, MS aAbstract |
Study objective |
Temperature control trials in cardiac arrest patients have not reliably conferred neuroprotective benefit but have been limited by inconsistent treatment parameters. To evaluate the presence of a time dependent treatment effect, we assessed the association between preinduction time and clinical outcomes.
Methods |
In this retrospective, single academic center study between 2014 and 2022, consecutive out-of-hospital cardiac arrest (OHCA) patients treated with temperature control were identified. Preinduction was defined as the time from hospital arrival to initiation of a closed-loop temperature feedback device [door to temperature control initiation time], and early door to temperature control device time was defined a priori as <3 hours. We assessed the association between good neurologic outcome (cerebral performance category 1 to 2) and door to temperature control device time using logistic regression. The proportion of patients who survived to hospital discharge was evaluated as a secondary outcome. A sensitivity analysis using inverse probability treatment weighting, created using a propensity score, was performed to minimize measurable confounding.
Results |
Three hundred and forty-seven OHCA patients were included; the early door to temperature control device cohort included 75 (21.6%) patients with a median (interquartile range) door to temperature control device time of 2.50 (2.03 to 2.75) hours, whereas the late door to temperature control device cohort included 272 (78.4%) patients with a median (interquartile range) door to temperature control device time of 5.18 (4.19 to 6.41) hours. In the multivariable logistic regression model, early door to temperature control device time was associated with improved good neurologic outcome and survival before [adjusted odds ratio (OR) (95% confidence interval) 2.36 (1.16 to 4.81) and 3.02 (1.54 to 6.02)] and after [adjusted OR (95% confidence interval) 1.95 (1.19 to 3.79) and 2.14 (1.33 to 3.36)] inverse probability of treatment weighting, respectively.
Conclusion |
In our study of OHCA patients, a shorter preinduction time for temperature control was associated with improved good neurologic outcome and survival. This finding may indicate that early initiation in the emergency department will confer benefit. Our findings are hypothesis generating and need to be validated in future prospective trials.
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| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Clifton Callaway, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: Rachel Beekman: Conceptualization, Supervision, Data curation, Formal analysis, Methodology, Writing - original draft, Writing - review and editing; Noah Kim: Data curation, Formal analysis, Methodology, Writing - review and editing; Christine Nguyen: Data curation, Formal analysis, Methodology, Writing - review and editing; George McGinniss: Data curation, Formal analysis, Methodology, Writing - review and editing; Yanhong Deng: Formal analysis, Methodology, Writing - review and editing; Eva Kitlen: Data curation, Methodology, Writing - original draft, Writing - review and editing; Gabriella Garcia: Data curation, Writing - review and editing; Charles Wira: Writing - review and editing; Akhil Khosla: Writing - review and editing; Jennifer Johnson: Data curation, Writing - review and editing; P. Elliott Miller: Writing - review and editing; Sarah Perman: Writing - review and editing; Kevin Sheth: Writing - review and editing; David Greer: Writing - review and editing; Emily J. Gilmore: Conceptualization, Supervision, Writing - review and editing. |
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| Data sharing statement: The entire deidentified dataset, data dictionary and analytic code for this investigation are available upon request from the date of article publication by contacting Rachel Beekman at Rachel.Beekman@yale.edu. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). This study was conducted without financial support. DG was the PI of the INTREPID study. KS receives grant support from NIH, AHA, Hyperfine, and Genentech. The remaining authors have no conflict of interest relevant to this article to disclose. |
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