The Extent of Myocardial Injury During Prolonged Targeted Temperature Management After Out-of-Hospital Cardiac Arrest

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Abstract

Aim The aim of this study is to evaluate the extent of myocardial injury by cardiac biomarkers during prolonged targeted temperature management of 24 hours vs 48 hours after out-of-hospital cardiac arrest. Methods This randomized Scandinavian multicenter study compares the extent of myocardial injury quantified by area under the curve (AUC) of cardiac biomarkers during prolonged targeted temperature management at 33°C ± 1°C of 24 hours and 48 hours, respectively. Through a period of 2.5 years, 161 comatose out-of-hospital cardiac arrest patients were randomized to targeted temperature management for 24 hours (n = 77) or 48 hours (n = 84). The AUC was calculated using both high-sensitivity cardiac troponin T (hs-cTnT AUC) and creatine kinase-myocardial band (CK-MB AUC) that were based upon measurements of these biomarkers every 6 hours upon admission until 96 hours after reaching target temperature. Results The median hs-cTnT AUC of 33,827 ng/L/h (interquartile range [IQR] 11,366-117,690) of targeted temperature management at 24 hours did not differ significantly from that of 28,973 ng/L/h (IQR 10,656-163,655) at 48 hours. In contrast, the median CK-MB AUC of 1829 μg/L/h (IQR 800-6799) during targeted temperature management at 24 hours was significantly lower than that of 2428 μg/L/h (IQR 1163-10,906) within targeted temperature management at 48 hours, P <.05. Conclusion This study of comatose out-of-hospital cardiac arrest survivors showed no difference between the extents of myocardial injury estimated by hs-cTnT AUC of prolonged targeted temperature management of 48 hours vs 24 hours, although the CK-MB AUC was significantly higher during 48 hours vs 24 hours. Hence, it seems unlikely that the duration of targeted temperature management has a beneficial effect on the extent of myocardial injury after out-of-hospital cardiac arrest, and may even have a worsening effect.

Original languageEnglish
JournalThe American Journal of Medicine
Volume130
Issue1
Pages (from-to)37-46
Number of pages10
ISSN0002-9343
DOIs
Publication statusPublished - Jan 2017

Keywords

  • Body temperature regulation
  • CK-MB
  • Heart arrest
  • Induced mild hypothermia
  • Out-of-hospital cardiac arrest
  • Targeted temperature management
  • Troponin T

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