PMID- 26202789 OWN - NLM STAT- MEDLINE DCOM- 20160308 LR - 20220318 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 19 IP - 1 DP - 2015 Jul 22 TI - Adverse events associated with poor neurological outcome during targeted temperature management and advanced critical care after out-of-hospital cardiac arrest. PG - 283 LID - 10.1186/s13054-015-0991-9 [doi] LID - 283 AB - INTRODUCTION: The aim of this study was to investigate the association of adverse events (AEs) during targeted temperature management (TTM) and other AEs and concomitant treatments during the advanced critical care period with poor neurological outcome at hospital discharge in adult out-of-hospital cardiac arrest (OHCA) patients. METHODS: This was a retrospective study using Korean Hypothermia Network registry data of adult OHCA patients treated with TTM in 24 teaching hospitals throughout South Korea from 2007 to 2012. Demographic characteristics, resuscitation and post-resuscitation variables, AEs, and concomitant treatments during TTM and the advanced critical care were collected. The primary outcome was poor neurological outcome, defined as a cerebral performance category (CPC) score of 3-5 at hospital discharge. The AEs and concomitant treatments were individually entered into the best multivariable predictive model of poor neurological outcome to evaluate the associations between each variable and outcome. RESULTS: A total of 930 patients, including 704 for whom a complete dataset of AEs and covariates was available for multivariable modeling, were included in the analysis; 476 of these patients exhibited poor neurological outcome [CPC 3 = 50 (7.1%), CPC 4 = 214 (30.4%), and CPC 5 = 212 (30.1%)]. Common AEs included hyperglycemia (45.6%), hypokalemia (31.3%), arrhythmia (21.3%) and hypotension (29%) during cooling, and hypotension (21.6%) during rewarming. Bleeding (5%) during TTM was a rare AE. Common AEs during the advanced critical care included pneumonia (39.6%), myoclonus (21.9%), seizures (21.7%) and hypoglycemia within 72 hours (23%). After adjusting for independent predictors of outcome, cooling- and rewarming-related AEs were not significantly associated with poor neurological outcome. However, sepsis, myoclonus, seizure, hypoglycemia within 72 hours and anticonvulsant use during the advanced critical care were associated with poor neurological outcome [adjusted odds ratios (95% confidence intervals) of 3.12 (1.40-6.97), 3.72 (1.93-7.16), 4.02 (2.04-7.91), 2.03 (1.09-3.78), and 1.69 (1.03-2.77), respectively]. Alternatively, neuromuscular blocker use was inversely associated with poor neurological outcome (0.48 [0.28-0.84]). CONCLUSIONS: Cooling- and rewarming-related AEs were not associated with poor neurological outcome at hospital discharge. Sepsis, myoclonus, seizure, hypoglycemia within 72 hours and anticonvulsant use during the advanced critical care period were associated with poor neurological outcome at hospital discharge in our study. FAU - Kim, Young-Min AU - Kim YM AD - Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. emart@catholic.ac.kr. FAU - Youn, Chun Song AU - Youn CS AD - Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. ycs1005@catholic.ac.kr. FAU - Kim, Soo Hyun AU - Kim SH AD - Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. unidgirl@catholic.ac.kr. FAU - Lee, Byung Kook AU - Lee BK AD - Department of Emergency Medicine, College of Medicine, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea. bbukkuk@hanmail.net. FAU - Cho, In Soo AU - Cho IS AD - Department of Emergency Medicine, KEPCO Medical Center, 308 Uicheon-ro, Dobong-gu, Seoul, 132-703, South Korea. mensa@hanmail.net. FAU - Cho, Gyu Chong AU - Cho GC AD - Department of Emergency Medicine, College of Medicine, Hallym University, Kangdong Sacread Heart Hospital 150 Seongan-ro, Gangdong-gu, Seoul, 134-701, South Korea. emdrcho@empal.com. FAU - Jeung, Kyung Woon AU - Jeung KW AD - Department of Emergency Medicine, College of Medicine, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea. neoneti@hanmail.net. FAU - Oh, Sang Hoon AU - Oh SH AD - Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. ohmytweety@catholic.ac.kr. FAU - Choi, Seung Pill AU - Choi SP AD - Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. emvic98@catholic.ac.kr. FAU - Shin, Jong Hwan AU - Shin JH AD - Department of Emergency Medicine, Boramae Medical Center, Seoul National University, 20 Boramae-ro, Dongjak-gu, Seoul, 156-707, South Korea. skyshiner@naver.com. FAU - Cha, Kyoung-Chul AU - Cha KC AD - Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju, Gangwon-do, 220-701, South Korea. mdcha94@naver.com. FAU - Oh, Joo Suk AU - Oh JS AD - Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. ohjoosuk@gmail.com. FAU - Yim, Hyeon Woo AU - Yim HW AD - Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. y1693@catholic.ac.kr. FAU - Park, Kyu Nam AU - Park KN AD - Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. emsky@catholic.ac.kr. CN - Korean Hypothermia Network Investigators LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20150722 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 RN - 0 (Anticonvulsants) RN - 0 (Neuromuscular Blocking Agents) SB - IM MH - Adult MH - Aged MH - Anticonvulsants/therapeutic use MH - Female MH - Hospitals, Teaching MH - Humans MH - Hypoglycemia/epidemiology MH - *Hypothermia, Induced MH - Male MH - Middle Aged MH - Myoclonus/epidemiology MH - Neuromuscular Blocking Agents/therapeutic use MH - Out-of-Hospital Cardiac Arrest/epidemiology/*therapy MH - Patient Discharge MH - *Patient Outcome Assessment MH - Registries MH - Republic of Korea/epidemiology MH - Retrospective Studies MH - *Rewarming MH - Seizures/drug therapy/epidemiology MH - Sepsis/epidemiology PMC - PMC4511983 FIR - Son, Yoo Dong IR - Son YD FIR - Lim, Hoon IR - Lim H FIR - Min, Jin Hong IR - Min JH FIR - Park, Jung Bae IR - Park JB FIR - Jang, Tae Chang IR - Jang TC FIR - You, Yeon Ho IR - You YH FIR - Kim, Kyung Hwan IR - Kim KH FIR - Lee, Byung Kook IR - Lee BK FIR - Kim, Won Young IR - Kim WY FIR - Lee, Dong Hoon IR - Lee DH FIR - Han, Chul IR - Han C FIR - Cho, Gyu Chong IR - Cho GC FIR - Kang, Gu Hyun IR - Kang GH FIR - Cho, In Soo IR - Cho IS FIR - Lee, Jong Seok IR - Lee JS FIR - Shin, Jonghwan IR - Shin J FIR - Suh, Gil Joon IR - Suh GJ FIR - Park, Kyu Nam IR - Park KN FIR - Park, Yoo Seok IR - Park YS FIR - Choi, Seung Pill IR - Choi SP FIR - Kim, Gi Woon IR - Kim GW FIR - Oh, Joo Suk IR - Oh JS FIR - Choi, Wook Jin IR - Choi WJ FIR - Cha, Kyoung Chul IR - Cha KC EDAT- 2015/07/24 06:00 MHDA- 2016/03/10 06:00 PMCR- 2015/07/22 CRDT- 2015/07/24 06:00 PHST- 2015/04/08 00:00 [received] PHST- 2015/06/19 00:00 [accepted] PHST- 2015/07/24 06:00 [entrez] PHST- 2015/07/24 06:00 [pubmed] PHST- 2016/03/10 06:00 [medline] PHST- 2015/07/22 00:00 [pmc-release] AID - 10.1186/s13054-015-0991-9 [pii] AID - 991 [pii] AID - 10.1186/s13054-015-0991-9 [doi] PST - epublish SO - Crit Care. 2015 Jul 22;19(1):283. doi: 10.1186/s13054-015-0991-9.