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Neurologic Outcomes in Rebound Pyrexia in Cardiac Arrest Patients Post Induced Hypothermia FREE TO VIEW

Bilal Safadi, MD; Chadi Hage, MD; MIchelle Deckard, RN; Timothy Ellender, MD
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Indiana University, Indianapolis, IN

Chest. 2013;144(4_MeetingAbstracts):391A. doi:10.1378/chest.1700534
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SESSION TITLE: Non Pulmonary Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM

PURPOSE: Induced Hypothermia (IH) has become the standard of care to improve neurologic outcomes in post cardiac arrest patients. The negative neurologic effects of rebound pyrexia (T ≥ 38°C) are established in cerebral vascular accident, but consequences of rebound pyrexia (RP) after IH have not been elucidated. We aimed to evaluate the impact of RP post IH on patient outcomes.

METHODS: This was a single-center prospectively collected registry of all patients (2010-11) treated with IH who survived 24 hours post completion of therapy. Patients were divided into two cohorts, euthermic (T < 38°C) and RP, based on temperature measurement at 24 hours post rewarming. We defined a cerebral performance category (CPC) of 1-2 as good neurologic outcome (GNO) and 3-5 as poor neurologic outcome (PNO). Specific patient variables including: ventilator free days (VFD), survival at discharge and hospital length of stay (LOS) were analyzed. Chi-squared was used for categorical variables and two-sample T-test for continuous variables in regards to death and CPC at discharge. Logistic regression models were used to assess the relationships of the clinical and demographic variables.

RESULTS: We included 204 patients and rebound pyrexia was seen in 91 patients (45%). GNO was seen in 38.9% of euthermic patients and 45.1% of the RP group (p=0.378). In patients with persistent fever, 41.7% had GNO (p=0.976). The mean maximum temperature in the GNO group was 38.0±0.7 compared to 37.9±1.0 (p=0.744) for PNO. The mean peak WBC was 14.7±6.3 for GNO and 17.2±8.8 for PNO (p=0.026). RP or persistent fevers were not significant predictors of VFD. Peak WBC (regression coefficient -0.04) was associated with decreased VFD. There were no significant predictors of overall LOS.

CONCLUSIONS: Rebound pyrexia was not associated with worse neurologic outcome, a difference in ventilator free days, or LOS. A lower peak WBC was associated with a significant improved neurologic outcome and increased VFD.

CLINICAL IMPLICATIONS: Rebound pyrexia in patients after completion of post cardiac arrest IH may not affect outcomes.

DISCLOSURE: The following authors have nothing to disclose: Bilal Safadi, Chadi Hage, MIchelle Deckard, Timothy Ellender

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