Temperature Management OHCA
Temperature management in ventilated adults admitted to Australian and New Zealand ICUs following out of hospital cardiac arrest
Goal: Our primary hypothesis is that there has been widespread adoption of TTM at 36°C in ANZ ICUs since the publication of the TTM trial. We further hypothesise that the mortality of OHCA patients in ANZ ICUs has been decreasing with time and that this temporal trend towards decreasing mortality has accelerated in association with the increased adoption of TTM at 36°C. This is a retrospective cohort study using data from the Australian and New Zealand Intensive Care Centre for Outcome and Resource Evaluation Adult Patient Database (ANZICS-CORE APD). The primary exposure of interest is the admission before vs. after publication of the TTM trial results in December 2013. Outcome variables The primary outcome variable of interest to evaluate the adoption of TTM in ANZ ICUs is the lowest temperature in the 1st 24 hours in ICU before and after the publication of the TTM trial (in December 2013). The primary clinical outcome variable of interest is in-hospital mortality.
Rationale: Out-of-hospital cardiac arrest (OHCA) carries a high risk for major neurological morbidity and mortality. Among comatose patients admitted to intensive care units (ICUs) following resuscitation from cardiac arrest, targeted temperature management appears to improve in neurological outcome and survival compared to strategies employing no temperature management. Prior to 2013, the standard of care involved cooling patients to 32-34°C for 12-24 hours. In 2013, the Targeted Temperature Management at 33°C versus 36°C After Cardiac Arrest trial (the TTM trial) revealed no difference in survival or major neurological disability between patients allocated to targeted temperature management at 33°C compared to those receiving temperature management at 36°C. However, the confidence intervals around survival estimates in the TTM trial (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51) did not preclude the possibility of clinically important benefit or harm with either temperature strategy. Moreover, recent data raise the possibility that implementation of a policy of targeted temperature management (TTM) at 36°C may reduce complications compared to TTM at 33°C.
Study Documents:
Study Statistical Analysis Plan
Contact: For further information about this study, please contact Glenn Eastwood by email.
