Hypothermic to ischemic ratio and mortality in post-cardiac arrest patients

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Skrifvars , M B , Soreide , E , Sawyer , K N , Taccone , F S , Toome , V , Storm , C , Jeppesen , A , Grejs , A , Duez , C H , Tiainen , M , Rasmussen , B S , Laitio , T , Hassager , C & Kirkegaard , H 2020 , ' Hypothermic to ischemic ratio and mortality in post-cardiac arrest patients ' , Acta Anaesthesiologica Scandinavica , vol. 64 , no. 4 , pp. 546-555 . https://doi.org/10.1111/aas.13528

Title: Hypothermic to ischemic ratio and mortality in post-cardiac arrest patients
Author: Skrifvars, Markus B.; Soreide, Eldar; Sawyer, Kelly N.; Taccone, Fabio S.; Toome, Valdo; Storm, Christian; Jeppesen, Anni; Grejs, Anders; Duez, Christophe H.; Tiainen, Marjaana; Rasmussen, Bodil S.; Laitio, Timo; Hassager, Christian; Kirkegaard, Hans
Contributor: University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, HUS Neurocenter
Date: 2020-04
Language: eng
Number of pages: 10
Belongs to series: Acta Anaesthesiologica Scandinavica
ISSN: 0001-5172
URI: http://hdl.handle.net/10138/329525
Abstract: Background We studied the associations between ischemia and hypothermia duration, that is, the hypothermic to ischemic ratio (H/I ratio), with mortality in patients included in a trial on two durations of targeted temperature management (TTM) at 33 degrees C. Methods The TTH48 (NCT01689077) trial compared 24 and 48 hours of TTM in patients after cardiac arrest. We calculated the hypothermia time from return of spontaneous circulation (ROSC) until the patient reached 37 degrees C after TTM and the ischemic time from CA to ROSC. We compared continuous variables with the Mann-Whitney U test. Using COX regression, we studied the independent association of the logarithmically transformed H/I ratio and time to death as well as interaction between time to ROSC, hypothermia duration, and intervention group. We visualized the predictive ability of variables with receiver operating characteristic curve analysis. Results Of the 338 patients, 237 (70%) survived for 6 months. The H/I ratio was 155 (IQR 111-238) in survivors and 114 (IQR 80-169) in non-survivors (P <.001). In a Cox regression model including factors associated with outcome in univariate analysis, the logarithmically transformed H/I ratio was a significant predictor of outcome (hazard ratio 0.52 (0.37-0.72, P = .001)). After removing an outlier, we found no interaction between time to ROSC and intervention group (P = .55) or hypothermia duration in quartiles (P = .07) with mortality. There was no significant difference in the area under the curve (AUC) between time to ROSC and H/I ratio (Delta AUC 0.03 95% CI -0.006-0.07, P = .10). Conclusions We did not find any consistent evidence of a modification of the effect of TTM based on ischemia duration.
Subject: TARGETED TEMPERATURE MANAGEMENT
THERAPEUTIC HYPOTHERMIA
RESUSCITATION
TIME
SURVIVAL
33-DEGREES-C
3126 Surgery, anesthesiology, intensive care, radiology
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