October 15, 2015Critical Care Medicine
Bradycardia During Targeted Temperature Management
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Discussion
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Implication
Randomized trial reveals lower mortality with bradycardia during targeted temperature management after cardiac arrest, indicating a marker of favorable recovery.
Key Points
- To evaluate whether bradycardia during targeted temperature management at 33°C is independently associated with favorable clinical outcomes following out-of-hospital cardiac arrest, and to assess heart rate responses at 36°C.
- Post hoc analysis of a prospective multicenter randomized trial conducted across 36 ICUs in 10 countries between 2010 and 2013.
- Included 877 comatose out-of-hospital cardiac arrest patients randomly assigned to targeted temperature management at 33°C (N=447) or 36°C (N=430), stratified by minimum heart rate (<50, 50–59, and ≥60 beats/min) at 12, 20, and 28 hours post-randomization.
- In the 33°C group, crude 180-day mortality increased with higher minimum heart rate: 32% for <50 beats/min, 43% for 50–59 beats/min, and 60% for ≥60 beats/min (p < 0.0001).
- Bradycardia under 50 beats/min at 33°C was independently associated with reduced 180-day mortality (adjusted HR = 0.50, 95% CI 0.34–0.74, p < 0.001) and lower odds of unfavorable neurologic outcome (adjusted OR = 0.38, 95% CI 0.21–0.68, p < 0.01).
- Similar, though less pronounced, independent associations between lower heart rate and favorable outcome were observed in patients managed at 36°C.
Cite This Study
Thomsen et al. (2015) studied this question.