Evaluation of neurological outcomes in patients with recovered cardiac arrest according to the targeted temperature management strategy performed

Abstract Background Following the publication of the Targeted Temperature Management-2 (TTM-2) trial, current cardiopulmonary resuscitation (CPR) guidelines recommend maintaining normothermia with early fever control as the temperature target in comatose patients after cardiac arrest (CA). Purpose The aim of this study was to evaluate the neurological outcomes of patients admitted to a Coronary Care Unit according to the temperature management strategy implemented (hypothermia vs. normothermia). Methods We conducted a retrospective analysis including all patients admitted to our Coronary Care Unit for recovered cardiac arrest between January 2021 and February 2024 who underwent temperature management. Clinical, demographic, laboratory, and imaging data collected at admission were analyzed. Results During the study period, 106 patients were admitted following recovery from cardiac arrest. Temperature management was performed in 58 patients (54%), of whom 34 (58%) underwent hypothermia at 33°C and 24 (42%) normothermia at 36.5°C. Baseline characteristics were similar between groups, with no statistically significant differences in mean age, sex, cardiovascular risk factors, substance use, or prior heart disease. No significant differences were observed in cardiac arrest characteristics, including the proportion of out-of-hospital and witnessed events, initial shockable rhythm, or No-Flow and return of spontaneous circulation (ROSC) times. The Glasgow Coma Scale score was lower in the hypothermia group (4.2 ± 1.7 vs. 5.26 ± 1.5, p = 0.014). Regarding neurological outcomes, the hypothermia group had a higher proportion of patients with favorable cerebral function as measured by the Cerebral Performance Category (50% vs. 21%, p = 0.037), fewer electroencephalograms (EEGs) showing severe injury patterns (52.9% vs. 63.9%, p = 0.002), and a greater proportion of EEGs with favorable prognostic features (46.2% vs. 8.7%, p = 0.023). No significant differences were observed in the incidence of seizures or status epilepticus, neuron-specific enolase levels, or infections. Conclusion In this cohort, treatment with hypothermia was associated with improved neurological outcomes. Larger, prospective studies are warranted to further evaluate the impact of modifying temperature management targets in comatose patients after CA.