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Mark J, Lopez J, Wahood W, Dodge J, Belaunzaran M, Losiniecki F, Santos-Roman Y, Danckers M. The role of targeted temperature management in 30-day hospital readmissions in cardiac arrest survivors: A national population-based study. IJC HEART & VASCULATURE 2023; 46:101207. [PMID: 37113651 PMCID: PMC10127122 DOI: 10.1016/j.ijcha.2023.101207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Background Targeted temperature management (TTM) implementation following resuscitation from cardiac arrest is controversial. Although prior studies have shown that TTM improves neurological outcomes and mortality, less is known about the rates or causes of readmission in cardiac arrest survivors within 30 days. We aimed to determine whether the implementation of TTM improves all-cause 30-day unplanned readmission rates in cardiac arrest survivors. Methods Using the Nationwide Readmissions Database, we identified 353,379 adult cardiac arrest index hospitalizations and discharges using the International Classification of Diseases, 9th and 10th codes. The primary outcome was 30-day all-cause unplanned readmissions following cardiac arrest discharge. Secondary outcomes included 30-day readmission rates and reasons, including impacts on other organ systems. Results Of 353,379 discharges for cardiac arrest with 30-day readmission, 9,898 (2.80%) received TTM during index hospitalization. TTM implementation was associated with lower 30-day all-cause unplanned readmission rates versus non-recipients (6.30% vs. 9.30%, p < 0.001). During index hospitalization, receiving TTM was also associated with higher rates of AKI (41.12% vs. 37.62%, p < 0.001) and AHF (20.13% vs. 17.30%, p < 0.001). We identified an association between lower rates of 30-day readmission for AKI (18.34% vs. 27.48%, p < 0.05) and trend toward lower AHF readmissions (11.32% vs. 17.97%, p = 0.05) among TTM recipients. Conclusions Our study highlights a possible negative association between TTM and unplanned 30-day readmission in cardiac arrest survivors, thereby potentially reducing the impact and burden of increased short-term readmission in these patients. Future randomized studies are warranted to optimize TTM use during post-arrest care.
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Affiliation(s)
- Justin Mark
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
- Corresponding author at: 3301 College Ave, Fort Lauderdale, FL 33314, United States.
| | - Jose Lopez
- Department of Internal Medicine, HCA Florida Aventura Hospital, FL, United States
| | - Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Joshua Dodge
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Miguel Belaunzaran
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Fergie Losiniecki
- Division of Clinical Cardiac Electrophysiology, Medical University of South Carolina, SC, United States
| | | | - Mauricio Danckers
- Division of Critical Care, HCA Florida Aventura Hospital, FL, United States
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Scholte NTB, van Wees C, Rietdijk WJR, van der Graaf M, Jewbali LSD, van der Jagt M, van den Berg RCM, Lenzen MJ, den Uil CA. Clinical Outcomes with Targeted Temperature Management (TTM) in Comatose Out-of-Hospital Cardiac Arrest Patients-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11071786. [PMID: 35407394 PMCID: PMC8999846 DOI: 10.3390/jcm11071786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/23/2023] Open
Abstract
Purpose: we evaluated the effects of the shift of a targeted temperature management (TTM) strategy from 33 °C to 36 °C in comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the Intensive Care Unit (ICU). Methods: we performed a retrospective study of all comatose (GCS < 8) OHCA patients treated with TTM from 2010 to 2018 (n = 798) from a single-center academic hospital. We analyzed 90-day mortality, and neurological outcome (CPC score) at ICU discharge and ICU length of stay, as primary and secondary outcomes, respectively. Results: we included 798 OHCA patients (583 in the TTM33 group and 215 in the TTM36 group). We found no association between the TTM strategy (TTM33 and TTM36) and 90-day mortality (hazard ratio (HR)] 0.877, 95% CI 0.677−1.135, with TTM36 as reference). Also, no association was found between TTM strategy and favorable neurological outcome at ICU discharge (odds ratio (OR) 1.330, 95% CI 0.941−1.879). Patients in the TTM33 group had on average a longer ICU LOS (beta 1.180, 95% CI 0.222−2.138). Conclusion: no differences in clinical outcomes—both 90-day mortality and favorable neurological outcome at ICU discharge—were found between targeted temperature at 33 °C and 36 °C. These results may help to corroborate previous trial findings and assist in implementation of TTM.
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Affiliation(s)
- Niels T. B. Scholte
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Correspondence:
| | - Christiaan van Wees
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Wim J. R. Rietdijk
- Department of Hospital Pharmacy, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
| | - Lucia S. D. Jewbali
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | | | - Mattie J. Lenzen
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
| | - Corstiaan A. den Uil
- Department of Intensive Care, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands;
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Spears W, Mian A, Greer D. Brain death: a clinical overview. J Intensive Care 2022; 10:16. [PMID: 35292111 PMCID: PMC8925092 DOI: 10.1186/s40560-022-00609-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/06/2022] [Indexed: 01/01/2023] Open
Abstract
Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. Its determination involves many considerations and subtleties. In this review, we discuss the philosophy and history of brain death, its clinical determination, and special considerations. We discuss performance of the main clinical components of the brain death exam: assessment of coma, cranial nerves, motor testing, and apnea testing. We also discuss common ancillary tests, including advantages and pitfalls. Special discussion is given to extracorporeal membrane oxygenation, target temperature management, and determination of brain death in pediatric populations. Lastly, we discuss existing controversies and future directions in the field.
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Affiliation(s)
- William Spears
- Department of Neurology, Boston University, Boston Medical Center, 85 East Concord Street, Room 1145, Boston, MA, 02118, USA
| | - Asim Mian
- Department of Radiology, Boston University, Boston Medical Center, 820 Harrison Avenue FGH, 3rd floor, Boston, USA
| | - David Greer
- Department of Neurology, Boston University, Boston Medical Center, 85 East Concord Street, Room 1145, Boston, MA, 02118, USA.
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Zhai Q, Duan J, Yu J, Zhang H, He X, Ma Q. Letter to the Editor: From Target Temperature Management Trial 1 to Trial 2: Therapeutic Hypothermia for Cardiac Arrest Discredited? Ther Hypothermia Temp Manag 2022. [PMID: 35231192 DOI: 10.1089/ther.2022.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Qiangrong Zhai
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Jingwei Duan
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Jie Yu
- The George Institute for Global Health, UNSW, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- The Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Xiaojun He
- Department of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Chinese Journal of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingbian Ma
- Department of Emergency, Peking University Third Hospital, Beijing, China
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5
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Kainz E, Fischer M. [Targeted temperature management after cardiac arrest : What is new?]. Anaesthesist 2022; 71:85-93. [PMID: 35050390 DOI: 10.1007/s00101-022-01091-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/15/2022]
Abstract
The current guidelines of the European Resuscitation Council recommend targeted temperature management to improve functional neurological outcome in comatose survivors after cardiac arrest. With the pathophysiological background of hypothermia-induced neuroprotection for prevention of hypoxic-ischemic encephalopathy, targeted temperature management is a key measure and represents a central aspect in postresuscitation care.In the 2021 guidelines the application of targeted temperature management in postresuscitation care has been recommended for all rhythms and irrespective of the location of cardiac arrest. Targeted temperature management is advocated for adult patients who remain unresponsive following return of spontaneous circulation (ROSC) after either out-of-hospital cardiac arrest or in-hospital cardiac arrest. The body temperature should be maintained at a constant value between 32 °C and 36 °C for at least 24 h. To avoid rebound hyperthermia, fever following targeted temperature management, defined as a temperature above 37.7 °C, should be prevented and treated for at least 72 h after ROSC in persistently comatose patients. The routine use of prehospital cooling by rapid infusion of large volumes of cold i.v. fluid immediately after ROSC is not recommended.Based on a systematic review of the current literature, this article summarizes the results of randomized trials and new findings on targeted temperature management in comatose adult patients after cardiac arrest. The review has a particular focus on the most recent evidence regarding the optimum range of target temperatures. Furthermore, recent data on preclinical management, different patient populations, the duration of targeted temperature management, cooling methods and rebound hyperthermia are discussed.The impact of targeted temperature management on neurological outcome after cardiac arrest has been a matter of controversy. Despite contradictory results and heterogeneity of study designs, the current evidence supports the relevance and the necessity of strict temperature control in postresuscitation care for neuroprotection and improvement in functional neurological outcomes.
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Affiliation(s)
- Elena Kainz
- Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Marlene Fischer
- Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Klinik für Intensivmedizin, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Affiliation(s)
- Laurie J Morrison
- From Rescu, Li Ka Shing Knowledge Institute and the Department of Emergency Services of St. Michael's Hospital, and the Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto (L.J.M.), and the Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon (B.T.) - all in Canada
| | - Brent Thoma
- From Rescu, Li Ka Shing Knowledge Institute and the Department of Emergency Services of St. Michael's Hospital, and the Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto (L.J.M.), and the Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon (B.T.) - all in Canada
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