Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/19431
Title: Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial.
Authors: Salter, Ryan;Bailey, Michael;Bellomo, Rinaldo;Eastwood, Glenn M;Goodwin, Andrew;Nielsen, Niklas;Pilcher, David;Nichol, Alistair;Saxena, Manoj;Shehabi, Yahya;Young, Paul
Affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand
Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
Intensive Care Unit, Monash Medical Centre, Melbourne, VIC, Australia
Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, VIC, Australia
School of Medicine, University of Melbourne, Melbourne, VIC, Australia
School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Faculty of Engineering and Information Technologies, University of Sydney, Sydney, NSW, Australia
Department of Clinical Sciences, Lund University, Lund, Sweden
Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
Division of Critical Care and Trauma, The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
University College Dublin-Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
Division of Critical Care and Trauma, George Institute for Global Health, Sydney, NSW, Australia
St George Clinical School, University of New South Wales, NSW, Australia
Issue Date: 30-Jul-2018
EDate: 2018-07-30
Citation: Critical care medicine 2018; online first: 30 July
Abstract: 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. Retrospective cohort study (January 2005 to December 2016). 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. Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest. The primary exposure of interest was admission before versus after publication of the target temperature management trial. 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]). 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.
URI: http://ahro.austin.org.au/austinjspui/handle/1/19431
DOI: 10.1097/CCM.0000000000003339
ORCID: 0000-0002-1650-8939
PubMed URL: 30063490
Type: Journal Article
Appears in Collections:Journal articles

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