Evidence map›Paper›PMID 28159575›Full record

ArticleResuscitation2017

Changing target temperature from 33°C to 36°C in the ICU management of out-of-hospital cardiac arrest: A before and after study.

Janet E Bray, Dion Stub, Jason E Bloom, Louise Segan, Biswadev Mitra, Karen Smith, Judith Finn, Stephen Bernard

Abstract read
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Article in Resuscitation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Janet E BrayDepartment of Epidemiology and Preventive Medicine, Monash University, Australia; The Alfred Hospital, Australia; Curtin University, Australia. Electronic address: janet.bray@monash.edu.
Dion StubDepartment of Epidemiology and Preventive Medicine, Monash University, Australia; The Alfred Hospital, Australia; Ambulance Victoria, Australia; Baker IDI Heart Diabetes Institute, Australia; The Western Hospital, Australia.
Jason E BloomThe Alfred Hospital, Australia.
Louise SeganDepartment of Epidemiology and Preventive Medicine, Monash University, Australia; The Alfred Hospital, Australia.
Biswadev MitraDepartment of Epidemiology and Preventive Medicine, Monash University, Australia; The Alfred Hospital, Australia.
Karen SmithDepartment of Epidemiology and Preventive Medicine, Monash University, Australia; Ambulance Victoria, Australia; The University of Western Australia, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Australia.
Judith FinnDepartment of Epidemiology and Preventive Medicine, Monash University, Australia; Curtin University, Australia.
Stephen BernardDepartment of Epidemiology and Preventive Medicine, Monash University, Australia; The Alfred Hospital, Australia; Ambulance Victoria, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn December 2013, our institution changed the target temperature management (TTM) for the first 24h in ventricular fibrillation out-of-hospital cardiac arrest (VF-OHCA) patients from 33°C to 36°C. This study aimed to examine the impact this change had on measured temperatures and patient outcomes.

methodsWe conducted a retrospective cohort study of consecutive VF-OHCA patients admitted to a tertiary referral hospital in Melbourne (Australia) between January 2013 and August 2015. Outcomes were adjusted for age and duration of cardiac arrest.

resultsOver the 30-month period, 76 VF-OHCA cases were admitted (24 before and 52 after the TTM change). Patient demographics, cardiac arrest features and hospital interventions were similar between the two periods. After the TTM change, less patients received active cooling (100% vs. 70%, p < 0.001), patients spent less time at target temperature (87% vs. 50%, p < 0.001), and fever rates increased (0% vs. 19%, p = 0.03). ​During the 36°C period, there was a decrease in the proportion of patients who were discharged: alive (71% vs. 58%, p=0.31), home (58% vs. 40%, p=0.08); and, with a favourable neurological outcome (cerebral performance category score 1-2: 71% vs. 56%, p=0.22).

conclusionAfter the change from a TTM target of 33°C to 36°C, we report low compliance with target temperature, higher rates of fever, and a trend towards clinical worsening in patient outcomes. Hospitals adopting a 36°C target temperature to need to be aware that this target may not be easy to achieve, and requires adequate sedation and muscle-relaxant to avoid fever.

Indexed as

Cardiopulmonary ResuscitationFeverHypothermia, InducedNervous System DiseasesOut-of-Hospital Cardiac ArrestAdultAgedAustraliaFemaleHumansIntensive Care UnitsMaleMiddle AgedOrganizational PolicyOutcome and Process Assessment, Health CareRetrospective StudiesCardiac arrestResuscitationTherapeutic hypothermia

Identifiers

PMID28159575

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.