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