Not All Temperature Control Is Equal: High-Quality Temperature Control Is Associated With Improved Outcomes Following Out-of-Hospital Cardiac Arrest - 19/11/25
, Christine Nguyen, BA a, Yanhong Deng, MPH e, Akash Chakravartty, MD a, Sarah M. Perman, MD, MSCE b, Charles Wira, MD b, Akhil Khosla, MD c, P. Elliott Miller, MD d, Kevin N. Sheth, MD a, David M. Greer, MD, MA f, Emily J. Gilmore, MD, MS aAbstract |
Study objectives |
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.
Methods |
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.
Results |
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).
Conclusion |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Out-of-hospital cardiac arrest, Temperature control, Outcomes, Quality
Plan
| Please see page 675 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Clifton Callaway, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: RB and EG: Conceptualization, methodology, validation, investigation, writing - original draft, writing - review and editing, and supervision. CN and AC: Methodology, statistics, investigation, writing - review and editing. YD, SP, CW, AK, P.M, KS, DG: Conceptualization, writing - review and editing. RB takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Data sharing statement: De-identified data set and code are available for sharing upon request. |
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| Fundingandsupport: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). RB received a small honorarium from ZOLL for a webinar on high-quality temperature control. KNS receives research grants through the National Institutes of Health, American Heart Association, Hyperfine, BARD, and Biogen, and consulting fees from Astrocyte, CSL Behring, Rhaeos, Cerevasc, Data Safety Monitoring Board for Sense, Phillips, and ZOLL. DMG receives research grants from the National Institutes of Health, and from Becton, Dickinson and Company for the INTREPID study, and a stipend as editor in chief for Seminars in Neurology. EJG receives research grants from the National Institutes of Health, honoraria and travel expenses from American Academy of Neurology, and consulting fees from Carpl.AI and the scientific advisory board for Union Chimique Belge. |
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Vol 86 - N° 6
P. 674-684 - décembre 2025 Retour au numéro
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