Cold fluids for induction of targeted temperature management : A sub-study of the TTH48 trial

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Holm , A , Kirkegaard , H , Taccone , F , Soreide , E , Grejs , A , Duez , C , Jeppesen , A , Toome , V , Hassager , C C , Rasmussen , B S , Laitio , T , Storm , C , Hästbacka , J & Skrifvars , M B 2020 , ' Cold fluids for induction of targeted temperature management : A sub-study of the TTH48 trial ' , Resuscitation , vol. 148 , pp. 90-97 . https://doi.org/10.1016/j.resuscitation.2019.11.031

Title: Cold fluids for induction of targeted temperature management : A sub-study of the TTH48 trial
Author: Holm, Aki; Kirkegaard, Hans; Taccone, Fabio; Soreide, Eldar; Grejs, Anders; Duez, Christophe; Jeppesen, Anni; Toome, Valdo; Hassager, Christian C.; Rasmussen, Bodil S.; Laitio, Timo; Storm, Christian; Hästbacka, Johanna; Skrifvars, Markus B.
Contributor: University of Helsinki, Medicum
University of Helsinki, Clinicum
University of Helsinki, HUS Emergency Medicine and Services
Date: 2020-03-01
Language: eng
Number of pages: 8
Belongs to series: Resuscitation
ISSN: 0300-9572
URI: http://hdl.handle.net/10138/325264
Abstract: Background: Pre-intensive care unit (ICU) induction of targeted temperature management (TTM) with cold intravenous (i.v.) fluids does not appear to improve outcomes after in out-of-hospital cardiac arrest (OHCA). We hypothesized that this may be due to ineffective cooling and side effects. Methods: A post hoc analysis of a sub-group of patients (n = 352) in the TTH48 trial (NCT01689077) who received or did not receive pre-ICU cooling using cold i.v. fluids. Data collection included patient characteristics, cardiac arrest factors, cooling methods, side effects and continuous core temperature measurements. The primary endpoint was the time to target temperature (TTT, Results: Of 352 patients included in the present analysis, 110 received pre-ICU cold fluids. The median time to the return of spontaneous circulation (ROSC) and TTT in the pre-ICU cold fluids group was longer than that of the group that did not receive pre-ICU cold fluids (318 vs. 281 min, p <0.01). In a linear regression model including the treatment centre, body mass index (BMI), chronic heart failure, diabetes mellitus and time to ROSC, the use of preICU cold i.v. fluids was not associated with a shorter time to the target temperature (standardized beta coefficient: 0.06, 95% CI for B -49 and 16, p = 0.32). According to the receipt or not of pre-ICU cold i.v. fluids, there was no difference in the proportion of patients with hypoxia (1.8% vs. 3.3%, p= 0.43) or the proportion of patients with electrolyte abnormalities (hyponatremia: 1.8% vs. 2.9% p= 0.54; hypokalaemia: 1.8% vs. 4.5%, p= 0.20). Furthermore, there was no difference in hospital mortality between the groups. Conclusions: The initiation of TTM with cold i.v. fluids before ICU arrival did not decrease the TTT. We detected no significant between-group difference in mortality or the incidence of side effects according to the administration or not of pre-ICU cold i.v fluids.
Subject: Targeted temperature management
Pre-ICU cooling
Time to target temperature
Intravenous cooling
HOSPITAL CARDIAC-ARREST
PREHOSPITAL THERAPEUTIC HYPOTHERMIA
OUTCOMES
TIME
RESUSCITATION
ASSOCIATION
INITIATION
SURVIVAL
ADULTS
CARE
3126 Surgery, anesthesiology, intensive care, radiology
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