Impact of Targeted Temperature Management on ED Patients with Drug Overdose–Related Cardiac Arrest

INTRODUCTION: Drug overdose is the leading cause of non-traumatic out-of-hospital cardiac arrest (OHCA) among young adults. This study investigates whether targeted temperature management (TTM) improves hospital survival from presumed overdose-related cardiac arrest. METHODS: Retrospective chart rev...

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Bibliographic Details
Published in:Journal of Medical Toxicology
Main Authors: Khan, Sharaf, Meyers, Chad M., Bentley, Suzanne, Manini, Alex F.
Format: Text
Language:English
Published: Springer US 2018
Subjects:
Original Article
Arctic
Online Access:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314931/
http://www.ncbi.nlm.nih.gov/pubmed/30411236
https://doi.org/10.1007/s13181-018-0686-0
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Summary:INTRODUCTION: Drug overdose is the leading cause of non-traumatic out-of-hospital cardiac arrest (OHCA) among young adults. This study investigates whether targeted temperature management (TTM) improves hospital survival from presumed overdose-related cardiac arrest. METHODS: Retrospective chart review of consecutive cardiac arrests presenting to an urban tertiary care hospital ED from 2011 to 2015. ED patients with cardiac arrest were included if < 50 years old, and excluded if there was a non-overdose etiology (e.g., trauma, ST-elevation myocardial infarction, subarachnoid hemorrhage). The main intervention was TTM, carried out with a combination of the Arctic Sun device and refrigerated crystalloid/antipyretics (goal temperature 33–36 °C). The primary outcome was survival to hospital discharge; neurologically intact survival was the secondary outcome. RESULTS: Of 923 patients with cardiac arrest, 802 (86.9%) met exclusion criteria, leaving 121 patients for final analysis. There were 29 patients in the TTM group (24.0%) vs 92 patients in the non-TTM group (76.0%). Eleven patients (9.1%) survived to hospital discharge. TTM was associated with increased odds of survival to hospital discharge (OR 11.3, 95% CI 2.8–46.3, p < 0.001), which increased substantially when palliative outcomes were excluded from the cohort (OR 117.3, 95% CI 17.0–808.4, p < 0.001). Despite achieving statistical significance (OR 1.1, 95% CI 1.0–1.3), TTM had no clinically significant effect on neurologically intact survival. CONCLUSIONS: TTM was associated with improved survival in ED patients with presumed drug overdose–related cardiac arrest. The impact of TTM on neurologically intact survival among these patients requires further study.

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