Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial

Ryan Salter, Michael Bailey, Rinaldo Bellomo, Glenn Eastwood, Andrew Goodwin, Niklas Nielsen, David Pilcher, Alistair Nichol, Manoj Saxena, Yahya Shehabi, Paul Young, Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE)

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Abstract

OBJECTIVES: To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the target temperature management trial.

DESIGN: Retrospective cohort study (January 2005 to December 2016).

SETTING: The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient database containing greater than 2 million admission episodes from 186 Australian and New Zealand ICUs.

PATIENTS: Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest.

INTERVENTIONS: The primary exposure of interest was admission before versus after publication of the target temperature management trial.

MEASUREMENTS AND MAIN RESULTS: The primary outcome variable to evaluate changes in temperature management was lowest temperature in the first 24 hours in ICU. The primary clinical outcome variable of interest was inhospital mortality. Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU. Mean ± SD lowest temperature in the first 24 hours in ICU in pre- and posttarget temperature management trial patients was 33.80 ± 1.71°C and 34.70 ± 1.39°C, respectively (absolute difference, 0.98°C [99% CI, 0.89-1.06°C]). Inhospital mortality rate decreased by 1.3 (99% CI, -1.8 to -0.9) percentage points per year from January 2005 until December 2013 and increased by 0.6 (99% CI, -1.4 to 2.6) percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99% CI, -0.6 to 4.4]). Fever occurred in 568 (12.8%) of 4,450 pretarget temperature management trial patients and 853 (16.5%) of 5,184 posttarget temperature management trial patients (odds ratio, 1.35 [99% CI, 1.16-1.57]).

CONCLUSIONS: The average lowest temperature of postcardiac arrest patients in the first 24 hours in ICU rose after publication of the target temperature management trial. This change was associated with an increased frequency of fever not seen in the target temperature management trial.

Original languageEnglish
Pages (from-to)1722-1730
Number of pages9
JournalCritical Care Medicine
Volume46
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

Cite this

Salter, R., Bailey, M., Bellomo, R., Eastwood, G., Goodwin, A., Nielsen, N., ... Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE) (2018). Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial. Critical Care Medicine, 46(11), 1722-1730. https://doi.org/10.1097/CCM.0000000000003339
Salter, Ryan ; Bailey, Michael ; Bellomo, Rinaldo ; Eastwood, Glenn ; Goodwin, Andrew ; Nielsen, Niklas ; Pilcher, David ; Nichol, Alistair ; Saxena, Manoj ; Shehabi, Yahya ; Young, Paul ; Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE). / Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial. In: Critical Care Medicine. 2018 ; Vol. 46, No. 11. pp. 1722-1730.
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title = "Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial",
abstract = "OBJECTIVES: To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the target temperature management trial.DESIGN: Retrospective cohort study (January 2005 to December 2016).SETTING: The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient database containing greater than 2 million admission episodes from 186 Australian and New Zealand ICUs.PATIENTS: Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest.INTERVENTIONS: The primary exposure of interest was admission before versus after publication of the target temperature management trial.MEASUREMENTS AND MAIN RESULTS: The primary outcome variable to evaluate changes in temperature management was lowest temperature in the first 24 hours in ICU. The primary clinical outcome variable of interest was inhospital mortality. Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU. Mean ± SD lowest temperature in the first 24 hours in ICU in pre- and posttarget temperature management trial patients was 33.80 ± 1.71°C and 34.70 ± 1.39°C, respectively (absolute difference, 0.98°C [99{\%} CI, 0.89-1.06°C]). Inhospital mortality rate decreased by 1.3 (99{\%} CI, -1.8 to -0.9) percentage points per year from January 2005 until December 2013 and increased by 0.6 (99{\%} CI, -1.4 to 2.6) percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99{\%} CI, -0.6 to 4.4]). Fever occurred in 568 (12.8{\%}) of 4,450 pretarget temperature management trial patients and 853 (16.5{\%}) of 5,184 posttarget temperature management trial patients (odds ratio, 1.35 [99{\%} CI, 1.16-1.57]).CONCLUSIONS: The average lowest temperature of postcardiac arrest patients in the first 24 hours in ICU rose after publication of the target temperature management trial. This change was associated with an increased frequency of fever not seen in the target temperature management trial.",
author = "Ryan Salter and Michael Bailey and Rinaldo Bellomo and Glenn Eastwood and Andrew Goodwin and Niklas Nielsen and David Pilcher and Alistair Nichol and Manoj Saxena and Yahya Shehabi and Paul Young and {Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE)}",
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Salter, R, Bailey, M, Bellomo, R, Eastwood, G, Goodwin, A, Nielsen, N, Pilcher, D, Nichol, A, Saxena, M, Shehabi, Y, Young, P & Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE) 2018, 'Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial', Critical Care Medicine, vol. 46, no. 11, pp. 1722-1730. https://doi.org/10.1097/CCM.0000000000003339

Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial. / Salter, Ryan; Bailey, Michael; Bellomo, Rinaldo; Eastwood, Glenn; Goodwin, Andrew; Nielsen, Niklas; Pilcher, David; Nichol, Alistair; Saxena, Manoj; Shehabi, Yahya; Young, Paul; Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE).

In: Critical Care Medicine, Vol. 46, No. 11, 01.11.2018, p. 1722-1730.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial

AU - Salter, Ryan

AU - Bailey, Michael

AU - Bellomo, Rinaldo

AU - Eastwood, Glenn

AU - Goodwin, Andrew

AU - Nielsen, Niklas

AU - Pilcher, David

AU - Nichol, Alistair

AU - Saxena, Manoj

AU - Shehabi, Yahya

AU - Young, Paul

AU - Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE)

PY - 2018/11/1

Y1 - 2018/11/1

N2 - OBJECTIVES: To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the target temperature management trial.DESIGN: Retrospective cohort study (January 2005 to December 2016).SETTING: The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient database containing greater than 2 million admission episodes from 186 Australian and New Zealand ICUs.PATIENTS: Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest.INTERVENTIONS: The primary exposure of interest was admission before versus after publication of the target temperature management trial.MEASUREMENTS AND MAIN RESULTS: The primary outcome variable to evaluate changes in temperature management was lowest temperature in the first 24 hours in ICU. The primary clinical outcome variable of interest was inhospital mortality. Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU. Mean ± SD lowest temperature in the first 24 hours in ICU in pre- and posttarget temperature management trial patients was 33.80 ± 1.71°C and 34.70 ± 1.39°C, respectively (absolute difference, 0.98°C [99% CI, 0.89-1.06°C]). Inhospital mortality rate decreased by 1.3 (99% CI, -1.8 to -0.9) percentage points per year from January 2005 until December 2013 and increased by 0.6 (99% CI, -1.4 to 2.6) percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99% CI, -0.6 to 4.4]). Fever occurred in 568 (12.8%) of 4,450 pretarget temperature management trial patients and 853 (16.5%) of 5,184 posttarget temperature management trial patients (odds ratio, 1.35 [99% CI, 1.16-1.57]).CONCLUSIONS: The average lowest temperature of postcardiac arrest patients in the first 24 hours in ICU rose after publication of the target temperature management trial. This change was associated with an increased frequency of fever not seen in the target temperature management trial.

AB - OBJECTIVES: To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the target temperature management trial.DESIGN: Retrospective cohort study (January 2005 to December 2016).SETTING: The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient database containing greater than 2 million admission episodes from 186 Australian and New Zealand ICUs.PATIENTS: Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest.INTERVENTIONS: The primary exposure of interest was admission before versus after publication of the target temperature management trial.MEASUREMENTS AND MAIN RESULTS: The primary outcome variable to evaluate changes in temperature management was lowest temperature in the first 24 hours in ICU. The primary clinical outcome variable of interest was inhospital mortality. Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU. Mean ± SD lowest temperature in the first 24 hours in ICU in pre- and posttarget temperature management trial patients was 33.80 ± 1.71°C and 34.70 ± 1.39°C, respectively (absolute difference, 0.98°C [99% CI, 0.89-1.06°C]). Inhospital mortality rate decreased by 1.3 (99% CI, -1.8 to -0.9) percentage points per year from January 2005 until December 2013 and increased by 0.6 (99% CI, -1.4 to 2.6) percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99% CI, -0.6 to 4.4]). Fever occurred in 568 (12.8%) of 4,450 pretarget temperature management trial patients and 853 (16.5%) of 5,184 posttarget temperature management trial patients (odds ratio, 1.35 [99% CI, 1.16-1.57]).CONCLUSIONS: The average lowest temperature of postcardiac arrest patients in the first 24 hours in ICU rose after publication of the target temperature management trial. This change was associated with an increased frequency of fever not seen in the target temperature management trial.

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DO - 10.1097/CCM.0000000000003339

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