This study aims to examine associations between different target temperatures used in Targeted Temperature Management (TTM) and survival, neurologic outcome, and sedative and paralytic use after cardiac arrest (CA).

Cardiac arrest remains a leading cause of neurological disability. TTM has become standard of care after CA, leading to improved neurological outcomes and survival. Initial trials targeted a temperature of 32-34°C, whereas subsequent studies suggested 36°C to be equally effective. However, few studies have examined paralytic and sedative requirements at these different temperatures, or how they might affect early neurologic recovery and arousal.

Using retrospective and prospective chart review data from the Multimodal Outcome CHAracterization in Comatose Cardiac Arrest (MOCHA) database, we evaluated the prevalence of paralytic and sedative use post-CA and neurologic recovery (as measured by rate of survival at discharge, GCS > 8, and spontaneous eye opening) between patients receiving TTM at 32-34°C (33C, n=183) and TTM at 35-37°C (36C, n=61). Significance was determined using Chi-squared, t-tests and multiple regression analyses.

Groups had similar demographics, comorbidities and CA characteristics, as well as rates of early TTM termination and time to normothermia. Survival and neurologic outcomes after CA did not differ in patients treated with TTM at 36°C or 33°C, even after controlling for confounders such as renal and liver function at presentation. TTM at 36°C is associated with less prevalence of paralytic and sedative use post-arrest, although average doses were similar among patients who did receive sedation.

Our results suggest that higher target temperature of 36°C compared to 33°C is associated with less paralytic and sedative use, although neurologic recovery and survival post-arrest is similar between groups. Future studies should characterize confounders to the neurologic exam, such as paralytic and sedative use, and examine their potential contribution to premature withdrawal of life-sustaining therapy.