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Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?

Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardi...

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Autores principales: Wang, I-Ting, Wang, Chieh-Jen, Chen, Chao-Hsien, Yang, Sheng-Hsiung, Chen, Chun-Yen, Huang, Yen-Chun, Lin, Chang-Yi, Wu, Chien-Liang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095041/
https://www.ncbi.nlm.nih.gov/pubmed/37048710
http://dx.doi.org/10.3390/jcm12072628
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author Wang, I-Ting
Wang, Chieh-Jen
Chen, Chao-Hsien
Yang, Sheng-Hsiung
Chen, Chun-Yen
Huang, Yen-Chun
Lin, Chang-Yi
Wu, Chien-Liang
author_facet Wang, I-Ting
Wang, Chieh-Jen
Chen, Chao-Hsien
Yang, Sheng-Hsiung
Chen, Chun-Yen
Huang, Yen-Chun
Lin, Chang-Yi
Wu, Chien-Liang
author_sort Wang, I-Ting
collection PubMed
description Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, p = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; p = 0.001) and survival at 28 days (58.06% vs. 29.25%; p = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM.
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spelling pubmed-100950412023-04-13 Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better? Wang, I-Ting Wang, Chieh-Jen Chen, Chao-Hsien Yang, Sheng-Hsiung Chen, Chun-Yen Huang, Yen-Chun Lin, Chang-Yi Wu, Chien-Liang J Clin Med Article Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, p = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; p = 0.001) and survival at 28 days (58.06% vs. 29.25%; p = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM. MDPI 2023-03-31 /pmc/articles/PMC10095041/ /pubmed/37048710 http://dx.doi.org/10.3390/jcm12072628 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wang, I-Ting
Wang, Chieh-Jen
Chen, Chao-Hsien
Yang, Sheng-Hsiung
Chen, Chun-Yen
Huang, Yen-Chun
Lin, Chang-Yi
Wu, Chien-Liang
Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?
title Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?
title_full Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?
title_fullStr Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?
title_full_unstemmed Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?
title_short Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?
title_sort optimal timing of targeted temperature management for post-cardiac arrest syndrome: is sooner better?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10095041/
https://www.ncbi.nlm.nih.gov/pubmed/37048710
http://dx.doi.org/10.3390/jcm12072628
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