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Cold fluids for induction of targeted temperature management: A sub-study of the TTH48 trial.

Abstract

BACKGROUND

Pre-intensive care unit (ICU) induction of targeted temperature management (TTM) with cold intravenous (i.v.) fluids does not appear to improve outcomes after in out-of-hospital cardiac arrest (OHCA). We hypothesized that this may be due to ineffective cooling and side effects.

METHODS

A post hoc analysis of a sub-group of patients (n = 352) in the TTH48 trial (NCT01689077) who received or did not receive pre-ICU cooling using cold i.v. fluids. Data collection included patient characteristics, cardiac arrest factors, cooling methods, side effects and continuous core temperature measurements. The primary endpoint was the time to target temperature (TTT, < 34 °C), and the secondary endpoints included the incidence of circulatory side effects, abnormal electrolyte levels and hypoxia within the first 24 h of ICU care. A difference of 1 h in the TTT was determined as clinically significant a priori.

RESULTS

Of 352 patients included in the present analysis, 110 received pre-ICU cold fluids. The median time to the return of spontaneous circulation (ROSC) and TTT in the pre-ICU cold fluids group was longer than that of the group that did not receive pre-ICU cold fluids (318 vs. 281 min, p < 0.01). In a linear regression model including the treatment centre, body mass index (BMI), chronic heart failure, diabetes mellitus and time to ROSC, the use of pre-ICU cold i.v. fluids was not associated with a shorter time to the target temperature (standardized beta coefficient: 0.06, 95% CI for B -49 and 16, p = 0.32). According to the receipt or not of pre-ICU cold i.v. fluids, there was no difference in the proportion of patients with hypoxia on ICU admission (1.8% vs. 3.3%, p = 0.43) or the proportion of patients with electrolyte abnormalities (hyponatremia: 1.8% vs. 2.9% p = 0.54; hypokalaemia: 1.8% vs. 4.5%, p = 0.20). Furthermore, there was no difference in hospital mortality between the groups.

CONCLUSIONS

The initiation of TTM with cold i.v. fluids before ICU arrival did not decrease the TTT. We detected no significant between-group difference in mortality or the incidence of side effects according to the administration or not of pre-ICU cold i.v fluids.

Authors+Show Affiliations

Faculty of Medicine, University of Helsinki, Helsinki, Finland.Research Center for Emergency Medicine, Department of Emergency Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway; Department Clinical Medicine, University of Bergen, Bergen, Norway.Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark.Research Center for Emergency Medicine, Department of Emergency Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.Department of Intensive Cardiac Care, North Estonia Medical Centre, Tallinn, Estonia.Department of Cardiology, Rigshospitalet and Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, and Clinical Institute, Aalborg University, Aalborg, Denmark.Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Finland.Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.Department of Anesthesiology, Intensive Care and Paine Medicine, University of Helsinki and Helsinki University Hospital, Finland.Department of Anesthesiology, Intensive Care and Paine Medicine, University of Helsinki and Helsinki University Hospital, Finland; Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland. Electronic address: markus.skrifvars@hus.fi.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31962179

Citation

Holm, Aki, et al. "Cold Fluids for Induction of Targeted Temperature Management: a Sub-study of the TTH48 Trial." Resuscitation, 2020.
Holm A, Kirkegaard H, Taccone F, et al. Cold fluids for induction of targeted temperature management: A sub-study of the TTH48 trial. Resuscitation. 2020.
Holm, A., Kirkegaard, H., Taccone, F., Soreide, E., Grejs, A., Duez, C., ... Skrifvars, M. B. (2020). Cold fluids for induction of targeted temperature management: A sub-study of the TTH48 trial. Resuscitation, doi:10.1016/j.resuscitation.2019.11.031.
Holm A, et al. Cold Fluids for Induction of Targeted Temperature Management: a Sub-study of the TTH48 Trial. Resuscitation. 2020 Jan 18; PubMed PMID: 31962179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cold fluids for induction of targeted temperature management: A sub-study of the TTH48 trial. AU - Holm,Aki, AU - Kirkegaard,Hans, AU - Taccone,Fabio, AU - Soreide,Eldar, AU - Grejs,Anders, AU - Duez,Christophe, AU - Jeppesen,Anni, AU - Toome,Valdo, AU - Hassager C,Christian, AU - Rasmussen,Bodil S, AU - Laitio,Timo, AU - Storm,Christian, AU - Hästbacka,Johanna, AU - Skrifvars,Markus B, Y1 - 2020/01/18/ PY - 2019/08/31/received PY - 2019/10/28/revised PY - 2019/11/29/accepted PY - 2020/1/22/entrez PY - 2020/1/22/pubmed PY - 2020/1/22/medline KW - Intravenous cooling KW - Pre-ICU cooling KW - Targeted temperature management KW - Time to target temperature JF - Resuscitation JO - Resuscitation N2 - BACKGROUND: Pre-intensive care unit (ICU) induction of targeted temperature management (TTM) with cold intravenous (i.v.) fluids does not appear to improve outcomes after in out-of-hospital cardiac arrest (OHCA). We hypothesized that this may be due to ineffective cooling and side effects. METHODS: A post hoc analysis of a sub-group of patients (n = 352) in the TTH48 trial (NCT01689077) who received or did not receive pre-ICU cooling using cold i.v. fluids. Data collection included patient characteristics, cardiac arrest factors, cooling methods, side effects and continuous core temperature measurements. The primary endpoint was the time to target temperature (TTT, < 34 °C), and the secondary endpoints included the incidence of circulatory side effects, abnormal electrolyte levels and hypoxia within the first 24 h of ICU care. A difference of 1 h in the TTT was determined as clinically significant a priori. RESULTS: Of 352 patients included in the present analysis, 110 received pre-ICU cold fluids. The median time to the return of spontaneous circulation (ROSC) and TTT in the pre-ICU cold fluids group was longer than that of the group that did not receive pre-ICU cold fluids (318 vs. 281 min, p < 0.01). In a linear regression model including the treatment centre, body mass index (BMI), chronic heart failure, diabetes mellitus and time to ROSC, the use of pre-ICU cold i.v. fluids was not associated with a shorter time to the target temperature (standardized beta coefficient: 0.06, 95% CI for B -49 and 16, p = 0.32). According to the receipt or not of pre-ICU cold i.v. fluids, there was no difference in the proportion of patients with hypoxia on ICU admission (1.8% vs. 3.3%, p = 0.43) or the proportion of patients with electrolyte abnormalities (hyponatremia: 1.8% vs. 2.9% p = 0.54; hypokalaemia: 1.8% vs. 4.5%, p = 0.20). Furthermore, there was no difference in hospital mortality between the groups. CONCLUSIONS: The initiation of TTM with cold i.v. fluids before ICU arrival did not decrease the TTT. We detected no significant between-group difference in mortality or the incidence of side effects according to the administration or not of pre-ICU cold i.v fluids. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/31962179/Cold_fluids_for_induction_of_targeted_temperature_management:_A_sub-study_of_the_TTH48_trial L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(20)30004-6 DB - PRIME DP - Unbound Medicine ER -