The Time to Temperature Study Group conducted a study to determine whether target temperature and time correlate to the neurologic outcome exhibited by patients with therapeutic hypothermia. Most of these patients have cardiac arrest after the restoration of spontaneous circulation. The appropriate way of treating such an issue is through mild therapeutic hypothermia, a common procedure in any academic emergency department. Mortiz Haugk et.al sought to determine the relationship by looking into historical data with cases similar to their research. The authors are part of the study group, with the mindset of creating a solution to similar problems in the future.
Cardiac arrest cases continue to increase as time progresses, with many researchers wondering whether the global warming issue might be a factor in the case. Hence, the researchers conduct their study using data from April 1995 to June 2008, whereby they found cases of 588 patients. There were previous analyses of these cases with a retrospective cohort study conducted by observers though it blinded their outcome. The first issue was to rule out the faults in previous studies then create a better analysis with new variables that will help narrow down to the causes of cardiac arrest.
The study has a single-center retrospective study of temperature and data collected from patient’s charts. The consent procedures and protocol came from Merical University of Vienna’s ethics committee and performed under the Declaration of Helsinki. The randomized controlled trials and registries were efficient in the study as they demonstrated different situations and variables present in several situations. The researchers expect a strong relationship between target temperature and time about the neurological outcome. Moreover, the hypothesis discussed in earlier studies would not improve the outcome, but help in showing a combined relation between the variables.
The nursing framework used in the study correlates the temperature of a patient under a period, whereby the researchers conduct periodic analysis of each wave. The median temperature used is 34 degrees Celsius, with time being between 158 and 209 minutes. The ratio derives from the change in temperature alongside its corresponding time, then the condition of a patient. The hypothesis drawn out is the neurological outcomes relates to the time and target temperature of a patient. In the introduction, the authors point out certain elements, which would make the relationship hard to relate to each other especially with the timing differences in previous studies.
The subjects enrolled in the study were in life threatening situations, not in a position to provide their opinion towards their trial enrollment, 75 percent mortality, and unconscious. The patients fitted the description required in running a proper analysis for the study. Moreover, it helped narrow down to the required number of patients for clear relations and study of changes in temperature, time and condition. Their criteria make sense and proper judgment of conditions required to create a clear analysis. The previous studies had huge ratios because they incorporated large variables and classifications in their studies, which did not meet most of the standards required in making a comprehensive resolution.
The study relies on data collected in previous years, implying that it lacks methods in conducting its tests. The approach made by the researchers was good since conducting the study in current times would take up their time and devotion, something that they do not have at their disposal. However, they state the various methods used in some of the studies such as the tympanic infrared thermometer, cerebral performance category, and a general-purpose temperature probe. The data used came from the Medical University’s Department of Emergency Medicine located in Vienna. The information used was for patients received in the emergency section with cardiac arrests and had restorations using spontaneous circulation and therapeutic hypothermia.
The research conducted provides valid methods, materials, and results towards the hypothesis. One of the constant element is the temperature, which makes it possible for the researchers to narrow down their objective. Moreover, they conduct a better restatement of the issue with proper methods and current devices, which provide a clear perspective in the analysis. The main interest in the study is restoring the spontaneous circulation to achieve temperature readings of 34 degrees Celsius or less. The researchers used esophageal temperature in their study since it is more reliable in conducting a better assessment than the urinary bladder’s tympanic temperature. The results provided a CPC 1 of good recovery and CPC 2 of moderate disability in the patients affected for six months. The secondary results showed all-cause mortality after six months of arrest.
The study collected 2,536 cases of cardiac arrest patients and narrowed down to 588 patients after the 1948 patients failed to meet the requirements. There was a second analysis of the 588 patients whereby the researchers divided the group into two: favorable outcomes and survivors. Moreover, the patients used in the analysis were available for analysis. Unfortunately, 17 patients died of analgesia, paralysis, and sedation. These downsides did not deter the quest to draw out the study’s conclusion and parameters of analysis. It has limitations of observational, retro perspective, descriptive single center registry, though its observers had a better perspective of the temperature data.
The study observed legal and ethical issues by confirming with the relevant authorities before conducting the study. Since the study does not incorporate direct testing on subjects, it avoids the scrutiny of whether the researchers used proper measures and care for their subjects. However, the data used does not show some crucial information such as heat transfer, cooling especially in the post-arrest. Moreover, it cripples their effort in conducting a proper study on some of the patients, since a large number of them did not meet the requirements due to poor analysis by the medics.
The study results showed a median time of 209 minutes from the inception of restoration to 34 degrees Celsius in a patient. The interquartile range is between 130 and 302 with patients showing favorable neurological outcomes. These findings are quite better than the previous median of 158 min and an interquartile of between 101 and 230 with patients showing unfavorable neurological outcomes. The two situations create adjustable odds ratio for the favorable neurological outcome, whereby longer times over target temperature becomes 1.86. It shows a 95 percent Cl with 1.03 to 3.38 with a ‘P’ value of 0.04. These results provide opportunities for future discoveries by nurses and researchers on making effective treatment measures for patients/
The researchers concluded that cardiac arrest patients in comatose show a faster decline in temperature from 34 degrees Celsius to a more favorable temperature. Treatment using therapeutic hypothermia after a return of spontaneous circulation proves to be an effective way of treating patients. It provides chances for faster and effective retrospective towards the poor neurologic outcome. However, the authors cite need to have observations on the topic since the issues continue to persist in normal times.
Reference
Haugk, M., Testori, C., Uranitsch, M., Holzer, M., Behringer, W., & Herkner, H. (2011). Relationship Between Time to Target Tempretaure and Outcome In Patients Treated With Therapeutic Hypothermia After Cardiac Arrest. Critical Care.
