Authors (including presenting author) :
Lau FM (1); Kwok WK (1); Siu KY (1); Yu KY (1); Kwok WL (1); Chan WM (1); Lai CK (1)
Affiliation :
(1): Adult Intensive Care Unit, Queen Mary Hospital
Introduction :
Targeted Temperature Management (TTM) is a neuroprotection strategy in the post-cardiac arrest care bundle as recommended by the American Heart Association. Heterogeneities exist among institutions in terms of targeted temperature range, duration of TTM, modalities of temperature regulation and rewarming approach. As such, the overall effectiveness of TTM remains uncertain. We conducted a literature review and revised the TTM guideline for post-cardiac arrest patients in our department based on the latest evidence.
Objectives :
1. To standardize practice on TTM for post-cardiac arrest patients.
2. To enhance post-resuscitation care in intensive care unit (ICU).
Methodology :
The TTM guideline was updated and implemented in April 2022. All post-cardiac arrest patients admitted to a 20-bed adult ICU from April 2022 to October 2022 were reviewed. Primary outcome was modified Rankin scale (mRS) score at 30 days. Secondary outcome was compliance with the guideline. Patients were divided into two groups (good vs poor functional outcomes) based on mRS score for further comparative analysis.
Result & Outcome :
During the study period, 33 post-cardiac arrest patients received TTM for at least 24 hours with a targeted temperature range of 35.0 – 36.0oC. Temperature control was achieved by either using a surface cooling device or heat exchanger for extracorporeal circulatory support. 17 (52%) episodes of cardiac arrest were cardiogenic cause. Median time from ROSC to initiation of TTM was 154 (87-309) minutes. 11 (33%) of them survived with a good functional outcome (defined as mRS score of 0 to 3) on day 30. Temperature of 5 (15%) patients exceeded the upper limit of targeted range during TTM period due to inappropriate setting of temperature regulating device (n = 1) and refractory non-infectious fever (n = 4). 4 (11%) patients presented with shivering during TTM which was subsequently controlled with pharmacological measures. No significant electrolyte disturbance was observed in all patients. A higher serum potassium level was associated with a poorer 30-day mRS score (4.1 vs. 3.6, p = 0.041). All nursing staff adhered strictly to core body temperature monitoring during TTM. The time from ROSC to initiation of TTM for 18 (55%) patients was longer than the expected time stated in the guideline, most of which were attributed to the need for immediate percutaneous coronary interventions after initiation of extracorporeal cardiopulmonary support.
Protocol-driven TTM targeting mild hypothermia for post-cardiac arrest patients is feasible and poses a low risk of adverse events. Laboratory parameters may be useful for the prediction of functional outcomes in this population.
