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Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study

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Abstract

Purpose

Few outcome data are available about temperature management after intraoperative cardiac arrest (IOCA). We describe targeted temperature management (TTM) (32–34 °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.

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Notes

  1. http://www.R-project.org. Accessed 14 September 2016.

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Acknowledgements

We thank A. Wolfe MD (Issy-les-Moulineaux, France) for helping to prepare the manuscript.

Author contribution

SL, A-LC, and NM conceived, designed, and supervised the trial. SL, A-LC, DG, NM, NP, PC, SR, BS, JB, ED, AS, BV, EB, JL, BM, BB, DS, SM, SL, and BS collected the data; and SL coordinated the data collection. SL, CM, QM, and MRR analyzed and interpreted the data. CM, QM, and MRR performed the statistical analysis. SL, ALC, and NM wrote the first draft of the paper. All authors approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France

    Anne-Laure Constant, David Grimaldi, Sybille Merceron, Jean-Pierre Bedos & Stephane Legriel

  2. Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, 75015, Paris, France

    Anne-Laure Constant

  3. Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France

    Nicolas Mongardon & Gilles Dhonneur

  4. Faculté de médecine, Université Paris Est, 8 avenue du général Sarrail, 94000, Créteil, France

    Nicolas Mongardon & Gilles Dhonneur

  5. Inserm, U955, Equipe 3 “Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires”, 8 avenue du général Sarrail, Créteil, France

    Nicolas Mongardon

  6. SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France

    Quentin Morelot, Matthieu Resche-Rigon & Claire Montlahuc

  7. Université Paris Diderot, Paris, France

    Quentin Morelot, Matthieu Resche-Rigon & Claire Montlahuc

  8. ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France

    Quentin Morelot, Matthieu Resche-Rigon & Claire Montlahuc

  9. Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges, France

    Nicolas Pichon & Emmanuelle Begot

  10. Department of Anesthesiology, Institut Gustave Roussy, 39, rue Camille-Desmoulins, 94805, Villejuif Cedex, France

    Lauriane Bordenave

  11. Department of Intensive Care Medicine, Foch Hospital, 40 rue Worth, 92150, Suresnes, France

    Alexis Soummer

  12. Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Avenue de la côte de Nacre, CS30001, 14033, Caen Cedex 9, France

    Bertrand Sauneuf & Jennifer Brunet

  13. Department of Anesthesiology and Critical Care, Assistance Publique des Hôpitaux de Paris, 100 boulevard du Général-Leclerc, 92110, Clichy la Garenne, France

    Sylvie Ricome

  14. Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France

    Benoit Misset & Cedric Bruel

  15. Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France

    Benoit Misset & Stephane Legriel

  16. Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    David Schnell & Julie Boisramé-Helms

  17. EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France

    Julie Boisramé-Helms

  18. Department of Anesthesiology, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France

    Etienne Dubuisson & Philippe Jullien

  19. Pôle d’Anesthésie Réanimation, CHU d’Angers, 4 rue Larrey, 49933, Angers Cedex 9, Angers, France

    Sigismond Lasocki

  20. LUNAM Université, CHU d’Angers, 49933, Angers Cedex, France

    Sigismond Lasocki

  21. Intensive Care Unit, Centre Hospitalier Sud-Francilien, 116 boulevard Jean Jaurès, 91106, Corbeil-Essonnes Cedex, France

    Pierrick Cronier

  22. Department of Anesthesiology and Critical Care, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France

    Belaid Bouhemad

  23. Department of Intensive Care Medicine, Hôpital Saint-Camill, 2 rue des Pères-Camiliens, 94360, Bry-sur-Marne, France

    Serge Carreira

  24. Department of Anesthesiology, Foch Hospital, 40 rue Worth, 92150, Suresnes, France

    Benoit Vandenbunder

  25. INSERM U970, Paris Cardiovascular Research Center, Paris, France

    Stephane Legriel

Authors
  1. Anne-Laure Constant
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  2. Nicolas Mongardon
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  3. Quentin Morelot
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  4. Nicolas Pichon
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  5. David Grimaldi
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  6. Lauriane Bordenave
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  7. Alexis Soummer
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  8. Bertrand Sauneuf
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  10. Sylvie Ricome
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  11. Benoit Misset
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  14. Julie Boisramé-Helms
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  15. Etienne Dubuisson
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  16. Jennifer Brunet
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  17. Sigismond Lasocki
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  18. Pierrick Cronier
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  19. Belaid Bouhemad
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  20. Serge Carreira
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  21. Emmanuelle Begot
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  22. Benoit Vandenbunder
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  23. Gilles Dhonneur
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  24. Philippe Jullien
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  25. Matthieu Resche-Rigon
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  26. Jean-Pierre Bedos
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  27. Claire Montlahuc
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  28. Stephane Legriel
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Corresponding author

Correspondence to Stephane Legriel.

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Funding

The study was supported by the French public funding agency Délégation à la Recherche Clinique et à l’Innovation (DRCI), Versailles, France.

Conflicts of interest

The authors declare no competing interests.

Additional information

Take-home message: TTM is used in less than one-third of patients after IOCA. Although 1-year functional outcome was lower in patients given TTM, TTM did not independently predict better functional outcome after IOCA in this study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

134_2017_4709_MOESM1_ESM.tiff

ESM Table 1. Year of intraoperative cardiac arrest occurrence in patients managed with and without targeted temperature management – 2000 to 2013 (TIFF 16875 kb)

134_2017_4709_MOESM2_ESM.docx

ESM Table 2. Causes of intraoperative cardiac arrest surgery in the 101 survivors admitted to the intensive care unit (DOCX 38 kb)

ESM Table 3. Temperature in the operating room in 101 patients with intraoperative cardiac arrest (DOCX 13 kb)

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Constant, AL., Mongardon, N., Morelot, Q. et al. Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study. Intensive Care Med 43, 485–495 (2017). https://doi.org/10.1007/s00134-017-4709-0

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