Clinical paperEffect of prolonged targeted temperature management on left ventricular myocardial function after out-of-hospital cardiac arrest − A randomised, controlled trial

AimTo evaluate post-cardiac arrest myocardial dysfunction during prolonged targeted temperature management (TTM) compared with standard TTM in comatose out-of-hospital cardiac arrest (OHCA) survivors.MethodsA randomised, controlled trial comparing myocardial function after TTM at 33 ±1 °C for 48 h compared with 24 h. A total of 105 OHCA patients were computer-randomised to 24 h (n = 50) or 48 h (n = 55) of TTM. Transthoracic echocardiography was performed after 24 h, 48 h and 72 h. Echocardiographic parameters were evaluated by an investigator who was blinded to randomisation. The primary endpoint was peak systolic mitral annular velocity (Ś) measured as the difference in the period from 24 h to 72 h. The model was adjusted for age, primary rhythm and heart rate. The secondary outcomes were global peak longitudinal strain, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and the diastolic measures e' and E/e'.ResultsThe mean difference of S' was significantly increased in the 48 h group compared with the 24 h group: −1.14 cm/s (−1.83; −0.45), p = 0.001. This difference was consistent after adjusting the data (p = 0.008). However, there were no significant changes between the study groups with respect to the adjusted secondary outcomes of global peak longitudinal strain (p = 0.07), LVEF (p = 0.31), TAPSE (p = 0.91), e' (p = 0.26) and E/e' (p = 0.18).ConclusionProlonged TTM at 33 °C of 48 h compared with 24 h in comatose OHCA survivors may improve the recovery of post-cardiac arrest left myocardial dysfunction demonstrated by the echocardiographic outcome, S'.ClinicalTrials.gov identifier: NCT02066753.