Article (Scientific journals)
Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study.
Constant, Anne-Laure; Mongardon, Nicolas; Morelot, Quentin et al.
2017In Intensive Care Medicine, 43 (4), p. 485-495
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Keywords :
Adult; Aged; Body Temperature; Electric Countershock; Female; France/epidemiology; Heart Arrest/mortality/therapy; Humans; Hypothermia, Induced/adverse effects/methods; Intensive Care Units; Intraoperative Complications/mortality/therapy; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Retrospective Studies; Time Factors; Treatment Outcome; Cardiopulmonary resuscitation; Coma/therapy; Hypothermia; Induced; Intraoperative complications/therapy
Abstract :
[en] PURPOSE: Few outcome data are available about temperature management after intraoperative cardiac arrest (IOCA). We describe targeted temperature management (TTM) (32-34 degrees C) modalities, adverse events, and association with 1-year functional outcome in patients with IOCA. METHODS: Patients admitted to 11 ICUs after IOCA in 2008-2013 were studied retrospectively. The main outcome measure was 1-year functional outcome. RESULTS: Of the 101 patients [35 women and 66 men; median age, 62 years (interquartile range, 42-72)], 68 (67.3%) were ASA PS I to III and 57 (56.4%) had emergent surgery. First recorded rhythms were asystole in 44 (43.6%) patients, pulseless electrical activity in 36 (35.6%), and ventricular fibrillation/tachycardia in 20 (19.8%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation (ROSC) were 0 min (0-0) and 10 min (4-20), respectively. The 30 (29.7%) patients who received TTM had an increased risk of infection (P = 0.005) but not of arrhythmia, bleeding, or metabolic/electrolyte disorders. By multivariate analysis, one or more defibrillation before ROSC was positively associated with a favorable functional outcome at 1-year (OR 3.06, 95% CI 1.05-8.95, P = 0.04) and emergency surgery was negatively associated with 1-year favorable functional outcome (OR 0.36; 95% CI 0.14-0.95, P = 0.038). TTM use was not independently associated with 1-year favorable outcome (OR 0.82; 95% CI 0.27-2.46, P = 0.72). CONCLUSIONS: TTM was used in less than one-third of patients after IOCA. TTM was associated with infection but not with bleeding or coronary events in this setting. TTM did not independently predict 1-year favorable functional outcome after IOCA in this study.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Constant, Anne-Laure
Mongardon, Nicolas
Morelot, Quentin
Pichon, Nicolas
Grimaldi, David
Bordenave, Lauriane
Soummer, Alexis
Sauneuf, Bertrand
Merceron, Sybille
Ricome, Sylvie
Misset, Benoît ;  Université de Liège - CHU > Soins Intensifs
Bruel, Cedric
Schnell, David
Boisrame-Helms, Julie
Dubuisson, Etienne
Brunet, Jennifer
Lasocki, Sigismond
Cronier, Pierrick
Bouhemad, Belaid
Carreira, Serge
Begot, Emmanuelle
Vandenbunder, Benoit
Dhonneur, Gilles
Jullien, Philippe
Resche-Rigon, Matthieu
Bedos, Jean-Pierre
Montlahuc, Claire
Legriel, Stephane
More authors (18 more) Less
Language :
English
Title :
Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study.
Publication date :
2017
Journal title :
Intensive Care Medicine
ISSN :
0342-4642
eISSN :
1432-1238
Publisher :
Springer, Heidelberg, Germany
Volume :
43
Issue :
4
Pages :
485-495
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 21 February 2020

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