The association of body mass index with time to target temperature and outcomes following post-arrest targeted temperature management

Marion Leary; Marisa J Cinousis; Mark E Mikkelsen; David F Gaieski; Benjamin S Abella; Barry D Fuchs

doi:10.1016/j.resuscitation.2013.10.027

The association of body mass index with time to target temperature and outcomes following post-arrest targeted temperature management

Resuscitation. 2014 Feb;85(2):244-7. doi: 10.1016/j.resuscitation.2013.10.027. Epub 2013 Nov 11.

Authors

Marion Leary¹, Marisa J Cinousis², Mark E Mikkelsen³, David F Gaieski², Benjamin S Abella⁴, Barry D Fuchs³

Affiliations

¹ Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States. Electronic address: marion.leary@uphs.upenn.edu.
² Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
³ Section of Pulmonary Allergy and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
⁴ Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States; Section of Pulmonary Allergy and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.

PMID: 24231571
DOI: 10.1016/j.resuscitation.2013.10.027

Abstract

Background: Evidence suggests that more rapid attainment of target temperature (32-34°C) improves neurologic outcome following cardiac arrest and targeted temperature management (TTM). It is unclear to what extent body mass index (BMI) is associated with the time to reach target temperature and subsequent clinical outcomes.

Objective: We sought to determine whether the time to target temperature was affected by BMI. In addition, we wished to determine whether the incidence of skin breakdown, survival to discharge and neurologic outcomes were associated with BMI.

Methods: Multicenter retrospective cohort study of cardiac arrest patients who underwent TTM between July 2007 and December 2012. We examined the association between BMI and the time from initiation of cooling to attainment of target temperature (32-34°C).

Results: Of 236 patients treated with TTM, 184 were included in the study. Mean age was 57.8±17.0 years; 78/184 (42%) were female and 48/184 (26%) had VF/VT as the initial rhythm. Median time to reach target temperature from ROSC was 6.4 (4.1, 9.8)h and median time from initiation of TTM to target temperature was 3.4 (2.1, 5.8)h. Cooling duration was a median of 24.0 (23.0, 24.0)h and median rewarming time was 12.0 (9.5, 18.0)h. Overall, 104/184 (56.5%) achieved target temperature within 4h and 128/184 (69.6%) within 6h. Increased BMI was associated with a longer time to achieve target temperature from initiation of TTM (p=0.01). There was no significant difference across BMI groups in time to achieve target temperature from ROSC (0.07), skin breakdown (p=0.35), survival (p=0.21), nor rate of good neurologic outcome (p=0.32).

Conclusions: Target temperature was frequently achieved within 4-6h; as BMI increased, the time to reach target temperature from initiation of TTM was prolonged. There was no significant difference across BMI groups for survival or good neurologic outcome.

Keywords: Adverse events; Body mass index; Cardiac arrest; Sudden death; Targeted temperature management; Therapeutic hypothermia.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index*
Body Temperature*
Cardiopulmonary Resuscitation / methods*
Female
Heart Arrest / therapy*
Humans
Hypothermia, Induced*
Male
Middle Aged
Pennsylvania
Retrospective Studies
Rewarming
Survival Rate
Treatment Outcome