Efficacy and Safety of 72-Hour Targeted Temperature Management in Comatose Asphyxial Arrest Survivors

944 of Emergency Medicine, Seoul National University Hospital, Seoul, KOREA. Objective: It is well known that rapid rewarming is related to poor outcome, but not as well known what kind of inflammatory processes occur during the rewarming period. We investigated what inflammatory mediators changed during the rewarming period after completion of therapeutic hypothermia for cardiac arrest victims. Methods: This study was conducted in an emergency intensive care unit (ICU) of a tertiary referral hospital. After informed consent, patients’ blood samples were collected at admission and 0 h, 2 h, 4 h, and 8 h after the start of rewarming. Inflammatory mediators (E-selectin, soluble inter-cellular adhesion molecule (ICAM), interleukin [IL]-10, IL-1ra, IL-6, IL-8, monocyte chemotactic protein-1, and tumor necrosis factor [TNF]-a) were measured using simultaneous Luminex Assay. Therapeutic hypothermia was applied for 24 h at 32 C. Rewarming after hypothermia was done for 8 h at the rate of 0.5 C. Results: Fifteen patients were enrolled and completed a schedule of 24 h hypothermia and 8 h rewarming. Levels of IL-10 showed significant change during the rewarming period; levels were decreased (basal: 30.5 6 61.0 pg/mL, rewarming 0 h: 4.3 6 8.8 pg/mL, rewarming 2 h: 4.4 6 10.6 pg/mL, rewarming 4 h: 3.6 6 8.8 pg/mL, rewarming 8 h: 2.7 6 3.7 pg/mL, p-value 0.042). Levels of MCP-1 showed a tendency to increase during the rewarming period but were not statistically definite (basal: 133.0 6 61.0 pg/mL, rewarming 0 h: 41.8 6 31.9 pg/mL, rewarming 2 h: 46.6 6 34.0 pg/mL, rewarming 4 h: 45.3 6 8.8 pg/mL, rewarming 8 h: 83.6 6 3.7 pg/mL, p-value = 0.06). E-selectin, s-ICAM, IL-6, IL-8, and TNF-a showed no significantly different levels during the rewarming period. All levels of IL-1ra were under detectable value. There were no inflammatory mediator level differences between good CPC (CPC 1, 2) and poor CPC (CPC 1–3) group. Conclusions: During the rewarming period, levels of IL-10 increased. Levels of other markers were not changed during the rewarming period. Further study is needed to achieve better understanding of the rewarming mechanism.

, EFFICACY AND SAFETY OF 72-HOUR TARGETED TEMPERATURE MANAGEMENT IN COMATOSE ASPHYXIAL ARREST SURVIVORS. B. K. Lee, K. W. Jeung, H. Y. Lee, G. S. Lee, Y. H. Jung, Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, KOREA. Objective: Targeted temperature management (TTM) aimed at the cardiac arrest survivors has been a standard treatment. The TTM method recommended by resuscitation guideline 2010 is aimed at a core temperature of 33 6 1  C during 12 to 24 h. The efficacy of the recommended TTM method in asphyxial arrest has not been proven. Therefore, we aimed to investigate the efficacy and safety of TTM aiming at a core temperature of 32 6 1  C during 72 h in asphyxial arrest. Methods: We included comatose asphyxial arrest survivors from January 2002 to May 2012. The patients were divided into three groups according to treatment methods (normothermia 2002–2005; 24-h TTM 2006–2010; 72-h TTM 2011 to May 2012). Clinical and neurological outcome data of three groups were compared. Neurolog-

Abstracts ical outcome was ranked as good or poor at discharge, with neurological outcome assessed according to the Cerebral Performance Category scale (CPC), with a poor outcome defined as a CPC 3–5. The incidences of complications after asphyxial arrest were also compared. Results: Normothermia, 24-h TTM, and 72h TTM groups were 18, 24, and 20 patients, respectively. The mean age was 45.7 6 16.4 years. The median interval between detection and return of spontaneous circulation (ROSC) was 30.0 (20.0–41.5) min. Asystole was most frequent rhythm (79.0%), and hanging was the most frequent cause of asphyxial arrest (56.5%). The baseline characteristics were not different among the three groups. Normothermia, 24-h TTM, and 72-h TTM groups showed 1 (4.5%), 2 (8.3%), and 0 (0.0%) of good neurological outcome, respectively, and neurological outcome was not different (p = 0.772). Frequent complications were hypokalemia (66.1%), seizure (54.8%), elevated amylase (40.3%), and bed sores (29.0%). However, the incidences of complications were not different. Conclusions: Seventy-two-hour TTM showed no improvement of neurological outcome compared with other methods. However, 72-h TTM can be used safely. Further study is required due to limitation of sample size. , PROGNOSTIC SIGNIFICANCE OF SERUM ALBUMIN ON LONG-TERM MORTALITY IN SURVIVORS FROM OUT-OF-HOSPITAL CARDIAC ARREST. I. W. Park, J. H. Lee, K. Kim, Y. H. Jo, K. Kang, J. Kim, C. Kang, S. Lee, C. J. Park, J. E. Lee, Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang, KOREA. Objective: Hypoalbuminemia is known as a reliable predictor of mortality in patients with various illnesses. However, the prognostic value of serum albumin on out-of-hospital cardiac arrest (OHCA) patients has not been established. The purpose of the study was to investigate whether serum albumin concentration on hospital arrival may be useful in predicting the long-term mortality in survivors of OHCA. Methods: A retrospective analysis of an Emergency Department OHCA registry from January 2008 to December 2011 was conducted. The individual medical records were reviewed for data, including Utstein predictors of OHCA, underlying disease, and initial laboratory finding, including serum albumin. Primary outcome was survival at 6 months. The secondary outcome was Cerebral Performance Category (CPC) at 6 months. Albumin was categorized as quartiles as < 2.7 g/dL, 2.7–3.2 g/dL, 3.2–3.9 g/dL, and > 3.9 g/dL. Hazard ratios were estimated using Cox proportional hazard models in both univariate and multivariate analysis. All prognostic variables with their p value < 0.1 in univariate analysis were used in multivariate analysis for adjustment. Results: Of 546 OHCA patients, 139 patients had sustained return of spontaneous circulation (ROSC). Of those, 23 patients (16.5%) survived at 6 months, and 16 patients (11.5%) had favorable neurological outcome (CPC 1, 2). Survival rates at 6 months were significantly higher in patients with a higher albumin group, and neurological outcomes were also more favorable in the higher albumin group. In a Cox proportional hazard regression analysis for 6-month survival, patients with lower categories of albumin had increased mortality rates before and after multivariable adjustment (p value for linear trend < 0.05). Conclusions: Serum