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 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.
['Khan|Sharaf|S|0000-0001-7687-1644', 'Meyers|Chad M|CM|', 'Bentley|Suzanne|S|', 'Manini|Alex F|AF|']
D000293:Adolescent D000328:Adult D016887:Cardiopulmonary Resuscitation D015331:Cohort Studies D062787:Drug Overdose D004632:Emergency Medical Services D005260:Female D006786:Hospitals, Urban D006801:Humans D007036:Hypothermia, Induced D016015:Logistic Models D008297:Male D008875:Middle Aged D058687:Out-of-Hospital Cardiac Arrest D012189:Retrospective Studies D062606:Tertiary Care Centers D016896:Treatment Outcome D055815:Young Adult
Targeted temperature management Cardiac arrest Toxicology