Abstract Body: Introduction: Temperature control is strongly recommended for comatose in-hospital cardiac arrest (IHCA) survivors. Variation in adherence and associations with outcomes have not been comprehensively assessed.
Research Question: What is the real-world variation in hospital temperature control practices for comatose IHCA survivors, and how is temperature strategy associated with outcomes?
Goals: Assess variation in adherence to temperature control recommendations after IHCA, and evaluate associations with outcomes.
Methods: This prospective, observational, multicenter cohort study included 24 hospital systems, with data collected from October 2023 to June 2024. We enrolled adult IHCA patients who survived the initial resuscitation and were eligible for temperature control. Primary exposure was documentation of a temperature control strategy within 24 hours post-arrest. The primary outcome was survival to hospital discharge. Secondary outcomes included use of temperature control therapy, fever (temperature ≥38°C), favorable functional outcome (Modified Rankin Scale ≤3), and favorable neurologic outcome (Cerebral Performance Category Score of ≤2).
Results: Among 1,006 enrolled patients, 615 (61.1%) remained comatose and were eligible for temperature control. Of the 615 eligible, 273 (44.4%) had a documented temperature control strategy. Having a documented temperature control strategy was associated with higher adjusted odds of receiving a temperature control therapy (aOR 21.3, 95%CI 12.3 – 36.7, P<0.01), and lower adjusted odds of having fever in the first 24 hours after resuscitation (aOR 0.63, 95%CI 0.43 – 0.92, P=0.02). Having a strategy, compared to not having one, had no statistically significant association with survival (32.6% vs. 28.1%, aOR 1.19, 95%CI 0.79 – 1.80, P=0.42), favorable functional outcome (9.9% vs. 10.5%, aOR 1.14, 95%CI 0.53 – 2.42, P=0.74), or favorable neurologic outcome (12.8% vs. 12.3%, aOR 1.15, 95%CI 0.63 – 2.12, P=0.65). Hospital system specific proportions of temperature control strategy ranged from 0% to 100%.
Conclusions: Among comatose IHCA survivors, more than half have no documented temperature control strategy. Patients with a temperature control strategy were less likely to have a fever in the first 24 hours after resuscitation and received more therapies for temperature control, but were not found to have improved survival or survival with good functional or neurologic outcomes when compared to those without a strategy.