Elsevier

Resuscitation

Volume 84, Issue 8, August 2013, Pages 1062-1067
Resuscitation

Clinical paper
Prevalence and effect of fever on outcome following resuscitation from cardiac arrest

https://doi.org/10.1016/j.resuscitation.2013.03.038Get rights and content

Abstract

Objective

Evaluate the prevalence of fever in the first 48 h after cardiac arrest and its effect on outcomes.

Methods

Review of patients treated between 1/1/2005 and 6/30/2010. Fever was defined as T  38.0 °C. We classified categories of post-cardiac arrest illness severity as (I) awake, (II) coma + mild cardiopulmonary dysfunction (SOFA cardiac + respiratory score <4), (III) coma + moderate-severe cardiopulmonary dysfunction, and (IV) deep coma. Associations between fever and survival or good neurologic outcome were examined between hypothermia (TH) and non-TH groups.

Results

In 336 patients, mean age was 60 years (SD 16), 63% experienced out-of-hospital cardiac arrest and 65% received TH. A shockable rhythm was present in 40%. Post arrest illness severity was category II in 38%, category III in 20%, and category IV in 42%. Fever was present in 42% of subjects, with a post-arrest median onset of 15 h in the non-TH cohort and 36 h in TH cohort. Fever was not associated with survival within the whole cohort (OR 0.32, CI 0.15, 0.68) or TH cohort (OR 1.21, CI 0.69, 2.14), but was associated with survival in non-TH cohort (OR 0.47, CI 0.20, 1.10). Fever was not associated with good outcomes in the whole cohort (OR 0.83, CI 0.49, 1.40), TH cohort (OR 1.09, CI 0.56, 2.12) or non-TH cohort (OR 0.34, CI 0.11, 1.06).

Conclusions

The development of fever within the first 48 h after ROSC is common. Fever is associated with death in non-TH patients. TH treatment appears to mitigate this effect, perhaps by delaying fever onset.

Introduction

In the United States, sudden cardiac arrests claim approximately 300,000 lives per year.1 Over the past decade, induced therapeutic hypothermia (TH) has been adopted to attenuate neurological injury after the return of spontaneous circulation (ROSC) after cardiac arrest.2, 3 TH has become an integral component of the American Heart Association's recommendations in post-arrest care.4

Conversely, hyperthermia exacerbates acute neurological injury and contributes to poor outcomes.5, 6, 7, 8, 9, 10, 11 As little as 1 °C increase in brain temperature adversely affects histologic and functional outcome after cerebral ischemia in rats and dogs.12, 13, 14 Clinical studies also find that post-arrest hyperthermia is associated with poor neurological outcomes.7, 9, 10, 11 However, these studies involved small sample sizes and were completed prior to the widespread use of TH. This study examines a larger and more diverse patient population to evaluate the consequences of fever in post-arrest patients with and without TH. The advances made in understanding the post-cardiac arrest syndrome15 and applying increasingly protocol-driven care,16 coupled with TH use, merit further evaluation of the association and predictive value between temperature and outcomes.

The aim of this study is to determine the association between the presence, degree, and duration of fever and outcomes after cardiac arrest, after adjustment for other factors associated with outcome. Secondary aims of the study were to determine the prevalence and timing of fever after cardiac arrest.

Section snippets

Setting

Data were collected as part of a prospective quality improvement database. The University of Pittsburgh Institutional Review Board deemed review and analysis of these quality improvement data as exempt.

Study population

A total of 618 patient records from a tertiary care facility were reviewed between 1/1/2005 and 6/30/2010. Subjects were adults (>18 years) admitted to the hospital after in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) with ROSC. We defined cardiac arrest as receiving

Results

A total of 336 patients were included in the analysis. Most were treated after development of a standardized post-cardiac arrest protocol (Fig. 2). Table 1 lists their demographic, cardiac arrest, and post-resuscitation characteristics. Overall, 141 patients (42%) developed fever within the 48 h after their arrest, and fever was less common in the TH cohort (79/221, 36%) than in the non-TH cohort (62/115, 54%) (Chi-square = 9.35; p = 0.002). The median low estimate of fever burden was 4 h (IQR 1, 11)

Discussion

Development of fever after cardiac arrest is a common occurrence (42%) but is less common in those treated with TH (36%) than in those not treated with TH (55%). Consistent with previous studies, fever is associated with lower survival in non-TH patients.7, 9, 10, 11 In our study, much of this non-TH cohort is from an earlier time period. As time progressed, staff education and system changes led to increased utilization of TH at our institution.16 Our finding that, within the TH cohort,

Conclusions

The development of fever within the first 48 h after ROSC from cardiac arrest is common in both TH and non-TH patients. Previous studies and our observations support the association between development of fever and death in non-TH patients. However, treatment with TH appears to mitigate this effect, perhaps by delaying fever onset.

Conflict of interest statement

The authors have no conflicts of interest to report.

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  • Cited by (0)

    A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.03.038.

    c

    For the group of The Post Cardiac Arrest Service researchers, see Appendix A.

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