Abstract 18146: Targeted Temperature Management After Cardiac Arrest: The Montreal Heart Institute experience

Introduction: TTM improves neurological function and survival in patients with cardiac arrest and an initially shockable rhythm. However, many centers do not restrict TTM to VF/VT patients as recent reports suggest that patients with non-shockable rhythms may also benefit. Hypothesis: Our objective was to report MHI experience using TTM, to evaluate short and long term mortality and neurological outcome using the Cerebral Performance Category scale in patients remaining in coma after suffering a cardiac arrest and managed with TTM, regardless of the initial rhythm. Methods: We performed a retrospective charts review of all TTM patients at MHI between 2008 and 2015. Primary outcome was a composite of mortality and poor neurological outcome at hospital discharge. Potential indicators include initial rhythm and treatment era (early, goal: 33°C; recent: 36°C). Lastly, we evaluated the long term outcomes in those who initially survived to hospital discharge. Results: A total of 147 patients (120 men, mean age 59.5±12.5 years) had TTM. Overall survival to hospital discharge with good neurological outcome was 45.6%, 44.4% in our earlier 33° cohort (n=133) and 57.1% in our more recent 36° experience (n=14), with no significant difference between era (mortality OR 0.598 (0.197-1.819, p = 0.3649). As expected, shockable rhythm was associated with a better outcome (OR: 0.212 (0.068-0.664), p=0.008). Of the eleven initial survivors with a poor neurological status (CPC ≥3), 4 died rapidly (within a month of hospital discharge), but 6 (54.5%) markedly improved their neurological status to CPC=1 while the CPC is unknown for one survivor. Long term survival for those alive at hospital discharge regardless of their neurological outcome at discharge and after a mean follow up of 38±26 months was available for 76 of the 78 initial overall survivors (and 2 lost to follow-up) and was 81.9%, or 40.1% overall from the time of TTM initiation. Conclusions: The survival of cardiac arrest patients treated with TTM at MHI is good and similar to the results from randomized-controlled trials, despite enrolling patients with non-shockable rhythms. Finally and interestingly, a significant proportion of survivors with poor neurological outcome at discharge improved at follow up.