Non-linear association between the time required to reaching temperature targets and the neurological outcome in patients undergoing targeted temperature management after out-of-hospital cardiac arrest: Observational multicentre cohort study

Tetsuro Nishimura; Toshihiro Hatakeyama; Hisako Yoshida; Satoshi Yoshimura; Takeyuki Kiguchi; Taro Irisawa; Tomoki Yamada; Kazuhisa Yoshiya; Changhwi Park; Takuya Ishibe; Yoshiki Yagi; Masafumi Kishimoto; Sung-Ho Kim; Yasuyuki Hayashi; Yusuke Ito; Taku Sogabe; Takaya Morooka; Haruko Sakamoto; Keitaro Suzuki; Fumiko Nakamura; Tasuku Matsuyama; Yohei Okada; Norihiro Nishioka; Satoshi Matsui; Shunsuke Kimata; Shunsuke Kawai; Yuto Makino; Tetsuhisa Kitamura; Taku Iwami; Yasumitsu Mizobata

doi:10.1016/j.resplu.2024.100607

Non-linear association between the time required to reaching temperature targets and the neurological outcome in patients undergoing targeted temperature management after out-of-hospital cardiac arrest: Observational multicentre cohort study

Resusc Plus. 2024 Apr 3:18:100607. doi: 10.1016/j.resplu.2024.100607. eCollection 2024 Jun.

Authors

Tetsuro Nishimura¹, Toshihiro Hatakeyama^{2

3}, Hisako Yoshida⁴, Satoshi Yoshimura⁵, Takeyuki Kiguchi⁶, Taro Irisawa⁷, Tomoki Yamada⁸, Kazuhisa Yoshiya⁹, Changhwi Park¹⁰, Takuya Ishibe¹¹, Yoshiki Yagi¹², Masafumi Kishimoto¹³, Sung-Ho Kim¹⁴, Yasuyuki Hayashi¹⁵, Yusuke Ito¹⁵, Taku Sogabe¹⁶, Takaya Morooka¹⁷, Haruko Sakamoto¹⁸, Keitaro Suzuki¹⁹, Fumiko Nakamura⁹, Tasuku Matsuyama²⁰, Yohei Okada^{5

21}, Norihiro Nishioka⁵, Satoshi Matsui²², Shunsuke Kimata⁵, Shunsuke Kawai⁵, Yuto Makino⁵, Tetsuhisa Kitamura²², Taku Iwami⁵, Yasumitsu Mizobata¹

Affiliations

¹ Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
² Department of Emergency and Critical Care Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan.
³ SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Medical Education Building, Suite 212, Honolulu, HI 96813, United States.
⁴ Department of Medical Statistics, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
⁵ Department of Preventive Services, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-Konoemachi, Sakyo-ku, Kyoto 606-8501, Japan.
⁶ Department of Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan.
⁷ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
⁸ Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31, Kitayamacho, Tennoji-ku, Osaka 543-0035, Japan.
⁹ Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
¹⁰ Department of Emergency Medicine, Tane General Hospital, 1-12-21, Kujyominami, Nishi-ku, Osaka 550-0025, Japan.
¹¹ Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka-Sayama, Osaka 589-8511, Japan.
¹² Osaka Mishima Emergency and Critical Care Center, 11-1, Minamiakutagawa-cho, Takatsuki, Osaka 569-1124, Japan.
¹³ Osaka Prefectural Nakakawachi Emergency and Critical Care Center, 3-4-13, Nishiiwata, Higashiosaka, Osaka 578-0947, Japan.
¹⁴ Senshu Trauma and Critical Care Center, 2-23, Rinkuoraikita, Izumisano, Osaka 598-8577, Japan.
¹⁵ Senri Critical Care Medical Center, Saiseikaisenri Hospital, 1-1-6, Tsukumodai, Suita, Osaka 565-0862, Japan.
¹⁶ Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 1-1-6, Tsukumodai, Suita, Osaka 565-0862, Japan.
¹⁷ Emergency and Critical Care Medical Center, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
¹⁸ Department of Pediatrics, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka 543-8555, Japan.
¹⁹ Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka 596-8522, Japan.
²⁰ Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
²¹ Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore.
²² Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.

Abstract

Purpose: We evaluated associations between outcomes and time to achieving temperature targets during targeted temperature management of out-of-hospital cardiac arrest.

Methods: Using Comprehensive Registry of Intensive Care for out-of-hospital cardiac arrest Survival (CRITICAL) study, we enrolled all patients transported to participating hospitals from 1 July 2012 through 31 December 2017 aged ≥ 18 years with out-of-hospital cardiac arrest of cardiac aetiology and who received targeted temperature management in Osaka, Japan. Primary outcome was Cerebral Performance Category scale of 1 or 2 one month after cardiac arrest, designated as "one-month favourable neurological outcome". Non-linear multivariable logistic regression analyses assessed the primary outcome based on time to reaching temperature targets. In patients subdivided into quintiles based on time to achieving temperature targets, multivariable logistic regression calculated adjusted odds ratios and 95% confidence intervals.

Results: We analysed 473 patients. In non-linear multivariable logistic regression analysis, p value for non-linearity was < 0.01. In the first quintile (< 26.7 minutes), second quintile (26.8-89.9 minutes), third quintile (90.0-175.1 minutes), fourth quintile (175.2-352.1 minutes), and fifth quintile (≥ 352.2 minutes), one-month favourable neurological outcome was 32.6% (31/95), 40.0% (36/90), 53.5% (53/99), 57.4% (54/94), and 37.9% (36/95), respectively. Adjusted odds ratios with 95% confidence intervals for one-month favourable neurological outcome in the first, second, third, and fifth quintiles compared with the fourth quintile were 0.38 (0.20 to 0.72), 0.43 (0.23 to 0.81), 0.77 (0.41 to 1.44), and 0.46 (0.25 to 0.87), respectively.

Conclusion: Non-linear multivariable logistic regression analysis could clearly describe the association between neurological outcome in patients with out-of-hospital cardiac arrest and the time from the introduction of targeted temperature management to reaching the temperature targets.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Emergency medical services; Emergency medicine; Resuscitation; Targeted temperature management.