Not All Temperature Control Is Equal: High-Quality Temperature Control Is Associated With Improved Outcomes Following Out-of-Hospital Cardiac Arrest.

Abstract

Temperature control for survivors of cardiac arrest is a complex bundled intervention with poorly defined optimal parameters. We defined high-quality temperature control initiation and evaluated the association between quality and clinical outcomes. In this retrospective single academic center study between January 1, 2014, and July 19, 2024, consecutive out-of-hospital cardiac arrest patients treated with temperature control were identified. Patients were assigned a temperature control quality score (range 0 to 6) based on the time from hospital arrival to temperature control device initiation and the use of adjunctive pharmacologic treatment for shivering thermogenesis within 6 hours from hospital arrival. Based on the nonlinear relationship between temperature control quality and outcomes, quality was binarized into low quality (less than 3) and high quality (more than 3). The primary outcome was survival to hospital discharge and the secondary outcome was favorable neurologic outcomes, defined as a Cerebral Performance Category score of 1 to 2. We assessed the association between primary and secondary outcomes and temperature control quality using logistic regression. A sensitivity analysis using inverse probability treatment weighting, created using a propensity score, was performed to minimize measurable confounding. Standardized mean difference was used to quantify the difference between groups. Of the 421 patients treated with temperature control, 194 (46.1%) received high-quality temperature control. Demographic factors, arrest-related details, and postresuscitation management were similar between the low-quality and high-quality groups with an overall small effect size, except for the time from cardiac arrest to achievement of target temperature, which occurred faster in patients with high-quality temperature control (median [interquartile range] 5.4 [4.1, 8.6] versus 8.8 [7.3, 11.0] hours; standardized mean difference=0.79). High-quality temperature control was associated with increased survival to hospital discharge and favorable neurologic outcomes before and after inverse probability treatment weighting (adjusted odds ratio [95% confidence interval] 2.75 [1.53 to 5.04] and 2.05 [1.10 to 3.91] versus 2.13 [1.37 to 3.34] and 1.94 [1.16 to 3.30], respectively). In our single-center study of out-of-hospital cardiac arrest patients, high-quality temperature control was associated with improved survival and good neurologic outcomes. Temperature control parameters are likely important and may influence the neuroprotective benefit of temperature control. Prospective multicenter studies are warranted to evaluate the effect of temperature control quality on patient outcomes.