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Delayed Fever and Neurological Outcome after Cardiac Arrest: A Retrospective Clinical Study

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Abstract

Background

The aim of this study was to evaluate the association between fever after the first days of ICU stay and neurological outcome after cardiac arrest (CA).

Methods

We retrospectively analyzed CA patients admitted to intensive care unit (ICU). Inclusion criteria: age ≥18 years, Glasgow Coma Scale score ≤8 at ICU admission and assessment of body core temperature (BCT) using bladder or intravascular probes. Exclusion criteria: ICU length of stay (LOS) <3 days and pregnancy. The primary endpoint was neurological outcome assessed with Cerebral Performance Category (CPC) scale 6 months after CA.

Results

One hundred thirty-two patients were analyzed. Fever was present in 105 (79.6 %) patients. Variables associated with unfavorable outcome were (1) older age (p < 0.0025); (2) non-shockable cardiac rhythms (p < 0.0001); (3) higher Simplified Acute Physiology Score (SAPS) II (p < 0.0001); (4) pupillary abnormalities at ICU admission (p < 0.018); and (5) elevated degree of maximal BCT (Tmax) during ICU stay (p < 0.046). After multivariate analysis, Tmax maintained a significant relationship with neurological outcome. An increase of 1 °C in Tmax during ICU stay decreased the odds ratio for a favorable outcome by a factor of 31 % (p < 0.001). Moreover, we discovered a significant interaction between the day of Tmax (t-Tmax) and Tmax (p = 0.004); the later Tmax occurs, the more deleterious effects are observed on outcome.

Conclusions

Fever is frequent after CA, and Tmax in ICU is associated with worsened neurological outcome. This association becomes stronger as the timing of Tmax extends further from the CA.

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References

  1. Roger VL, Go AS, Lloyd-Jones et al., American Heart Association, Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012; 125: e2–e220

  2. Atwood C, Eisenberg MS, Herlitz J, et al. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005;67:75–80.

    Article  PubMed  Google Scholar 

  3. Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004;30(11):2126–8.

    Article  PubMed  Google Scholar 

  4. Dietrich WD, Busto R, Valdes I, Loor Y. Effects of normothermic versus mild hyperthermic forebrain ischemia in rats. Stroke. 1990;21(9):1318–25.

    Article  CAS  PubMed  Google Scholar 

  5. Wass CT, Lanier WL, Hofer RE, Scheithauer BW, Andrews AG. Temperature changes of ≥1 °C alter functional neurologic outcome and histopathology in a canine model of complete cerebral ischemia. Anesthesiology. 1995;83(2):325–35.

    Article  CAS  PubMed  Google Scholar 

  6. Baena RC, Busto R, Dietrich WD, Globus MY, Ginsberg MD. Hyperthermia delayed by 24 hours aggravates neuronal damage in rat hippocampus following global ischemia. Neurology. 1997;48(3):768–73.

    Article  CAS  PubMed  Google Scholar 

  7. Hickey RW, Kochanek PM, Ferimer H, Alexander HL, Garman RH, Graham SH. Induced hyperthermia exacerbates neurologic neuronal histologic damage after asphyxia cardiac arrest in rats. Crit Care Med. 2003;31(2):531–5.

    Article  PubMed  Google Scholar 

  8. Zeiner A, Holzer M, Sterz F, et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med. 2001;161(16):2007–12.

    Article  CAS  PubMed  Google Scholar 

  9. Leary M, Grossestreuer AV, Iannacone S, et al. Pyrexia and neurologic outcomes after therapeutic hypothermia for cardiac arrest. Resuscitation. 2013;84(8):1056–61.

    Article  PubMed  Google Scholar 

  10. Winters SA, Wolf KH, Kettinger SA, Seif EK, Jones JS, Bacon-Baguley T. Assessment of risk factors for post-rewarming “rebound hyperthermia” in cardiac arrest patients undergoing therapeutic hypothermia. Resuscitation. 2013;84(9):1245–9.

    Article  CAS  PubMed  Google Scholar 

  11. Bro-Jeppesen J, Hassager C, Wanscher M, et al. Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest. Resuscitation. 2013;84(12):1734–40.

    Article  PubMed  Google Scholar 

  12. Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC. Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke. 2008;39:3029–35.

    Article  PubMed  Google Scholar 

  13. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346(8):557–63.

    Article  PubMed  Google Scholar 

  14. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549–56.

    Article  Google Scholar 

  15. Nielsen N,Wetterslev J, Cronberg T et al, TTM trial investigators. Targeted temperature management at 33 °C versus 36 °C after cardiac arrest. N Engl J Med 2013; 369(23): 2197–2206.

  16. Dietrich WD, Bramlett HM. Hyperthermia and central nervous system injury. Prog Brain Res. 2007;162:201–17.

    Article  CAS  PubMed  Google Scholar 

  17. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.

    Article  CAS  PubMed  Google Scholar 

  18. American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112:IV-1–-211.

    Article  Google Scholar 

  19. American Heart Association. International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010;122:S249–638.

    Article  Google Scholar 

  20. Peberdy MA, Cretikos M, Abella BS, et al. Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an Utstein-style scientific statement. A scientific statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Resuscitation. 2007;75(3):412–33.

    Article  PubMed  Google Scholar 

  21. Takino M, Okada Y. Hyperthermia following cardiopulmonary resuscitation. Intensive Care Med. 1991;17(7):419–20.

    Article  CAS  PubMed  Google Scholar 

  22. Takasu A, Saitoh D, Kaneko N, Sakamoto T, Okada Y. Hyperthermia: is it an ominous sign after cardiac arrest? Resuscitation. 2001;49(3):273–7.

    Article  CAS  PubMed  Google Scholar 

  23. Bouwes A, Robillard LB, Binnekade JM, et al. The influence of rewarming after therapeutic hypothermia on outcome after cardiac arrest. Resuscitation. 2012;83(8):996–1000.

    Article  PubMed  Google Scholar 

  24. Gebhardt K, Guyette FX, Doshi AA, Callaway CW, Rittenberger JC. Post Cardiac Arrest Service. Prevalence and effect of fever on outcome following resuscitation from cardiac arrest. Resuscitation. 2013;84(8):1062–7.

    Article  PubMed  Google Scholar 

  25. Cocchi MN, Boone MD, Giberson B, et al. Fever after rewarming: incidence of pyrexia in postcardiac arrest patients who have undergone mild therapeutic hypothermia. J Intensive Care Med. 2014;29(6):365–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Suffoletto B, Pederby MA, van der Hoek T, Callaway C. Body temperature changes are associated with outcomes following in-hospital cardiac arrest and return of spontaneous circulation. Resuscitation. 2009;80(12):1365–70.

    Article  PubMed  Google Scholar 

  27. Perman SM, Goyal M, Neumar RW, Topjian AA, Gaieski DF. Clinical applications of targeted temperature management. Chest. 2014;145(2):386–93.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dragancea I, Rundgren M, Englund E, Friberg H, Cronberg T. The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest. Resuscitation. 2013;84(3):337–42.

    Article  PubMed  Google Scholar 

  29. Lemiale V, Dumas F, Mongardon N, et al. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39(11):1972–80.

    Article  PubMed  Google Scholar 

  30. Gofton TE, Young GB. Sepsis-associated encephalopathy. Nat Rev Neurol. 2012;8(10):557–66.

    Article  CAS  PubMed  Google Scholar 

  31. Stubbs DJ, Yamamoto AK, Menon DK. Imaging in sepsis-associated encephalopathy–insights and opportunities. Nat Rev Neurol. 2013;9(10):551–61.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Mario Mergoni MD and Tracy K. McIntosh PhD for their valuable suggestions.

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Authors and Affiliations

  1. Servizio Anestesia Rianimazione, Azienda Ospedaliero Universitaria di Parma, Parma, Italy

    Edoardo Picetti, Marta Velia Antonini & Maria Luisa Caspani

  2. Scuola di Specializzazione in Neurologia, Università degli Studi di Parma, Parma, Italy

    Yerma Bartolini & Laura Delaj

  3. Scuola di Specializzazione in Anestesia e Rianimazione, Università degli Studi di Parma, Parma, Italy

    Antonino DeAngelis & Fabio Villani

  4. Unità Operativa di Neurologia, Azienda Ospedaliero Universitaria di Parma, Parma, Italy

    Irene Florindo

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  1. Edoardo Picetti
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  2. Marta Velia Antonini
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Correspondence to Edoardo Picetti.

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All the authors declare that they have no conflict of interest.

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Picetti, E., Antonini, M.V., Bartolini, Y. et al. Delayed Fever and Neurological Outcome after Cardiac Arrest: A Retrospective Clinical Study. Neurocrit Care 24, 163–171 (2016). https://doi.org/10.1007/s12028-016-0251-0

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  • DOI: https://doi.org/10.1007/s12028-016-0251-0

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