Abstract
Backgrounds: Most out-of-hospital cardiac arrest (OHCA) survivors are comatose due to hypoxic ischemic brain injury. Targeted temperature management (TTM) is the only evidence-based neuroprotective intervention for this condition; however, the optimal implementation of TTM has yet to be determined. The concept of high-quality TTM has been proposed to improve patient outcomes, but its clinical impact has not been thoroughly evaluated. This study investigates whether adherence to high-quality TTM is associated with improved neurological outcomes and survival among OHCA patients. Methods: This retrospective analysis used data from the Korean Hypothermia Network Prospective Registry 1.0, including 1060 adult OHCA patients treated with TTM at 33 °C between 2015 and 2018. High-quality TTM was defined as follows: temperature variability during maintenance within ±1.0 °C, maintenance duration ≥ 24 h, rewarming rate ≤ 0.5 °C/h, and post-TTM fever control (temperature < 38.5 °C). Patients were classified into high- and low-quality TTM groups. The primary outcomes were survival and neurological status (CPC ranging from 1 to 2 indicated a good outcome) 6 months after cardiac arrest (CA). Results: Of the 1060 patients, 491 (46.3%) received high-quality TTM. Compared with the low-quality TTM group, the high-quality TTM group had higher rates of survival (44.6% vs. 36.4%, p = 0.006). Multivariate analysis revealed that high-quality TTM was independently associated with survival (OR 1.802, 95% CI: 1.171-2.773) and good neurological outcomes (OR 1.748, 95% CI: 1.102-2.770). Conclusions: High-quality TTM is associated with improved survival and better neurological outcomes in OHCA patients. Standardizing TTM delivery on the basis of quality metrics may increase its effectiveness in clinical practice.