Assessment of risk factors for post-rewarming “rebound hyperthermia” in cardiac arrest patients undergoing therapeutic hypothermia

• Published in: Resuscitation 2013-09, Vol.84 (9), p.1245-1249
• Main Authors: Winters, S.A, Wolf, K.H, Kettinger, S.A, Seif, E.K, Jones, J.S, Bacon-Baguley, T
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Analysis of Variance; Cardiac arrest; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - mortality; Cohort Studies; Combined Modality Therapy; Emergency; Female; Fever - etiology; Fever - mortality; Fever - physiopathology; Follow-Up Studies; Hospital Mortality - trends; Humans; Hypothermia, Induced - methods; Length of Stay; Male; Middle Aged; Mortality; Nervous System Diseases - etiology; Nervous System Diseases - mortality; Nervous System Diseases - physiopathology; Neurologic morbidity; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Rebound hyperthermia; Retrospective Studies; Rewarming - adverse effects; Risk Assessment; Sex Factors; Statistics, Nonparametric; Survival Rate; Therapeutic hypothermia; Treatment Outcome; Young Adult
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2013.03.027

Abstract Introduction The outcomes associated with therapeutic hypothermia (TH) after cardiac arrest, while overwhelmingly positive, may be associated with adverse events. The incidence of post-rewarming rebound hyperthermia (RH) has been relatively unstudied and may worsen survival and neurologic outcome. The purpose of this study was to determine the incidence and risk factors associated with RH as well as its relationship to mortality, neurologic morbidity, and hospital length of stay (LOS). Methods A retrospective, observational study was performed of adult patients who underwent therapeutic hypothermia after an out-of-hospital cardiac arrest. Data describing 17 potential risk factors for RH were collected. The primary outcome was the incidence of RH while the secondary outcomes were mortality, discharge neurologic status, and LOS. Results 141 patients were included. All 17 risk factors for RH were analyzed and no potential risk factors were found to be significant at a univariate level. 40.4% of patients without RH experienced any cause of death during the initial hospitalization compared to 64.3% patients who experienced RH (OR: 2.66; 95% CI: 1.26–5.61; p = 0.011). The presence of RH is not associated with an increase in LOS (10.67 days vs. 9.45 days; absolute risk increase = −1.21 days, 95% CI: −1.84 to 4.27; p = 0.434). RH is associated with increased neurologic morbidity ( p = 0.011). Conclusions While no potential risk factors for RH were identified, RH is a marker for increased mortality and worsened neurologic morbidity in cardiac arrest patients who have underwent TH.