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The Extent of Myocardial Injury During Prolonged Targeted Temperature Management After Out-of-Hospital Cardiac Arrest Anders Morten Grejs, MD, Jakob Gjedsted, MD, PhD, Kristian Thygesen, MD, DMSc, Jens Flensted Lassen, MD, PhD, Bodil Steen Rasmussen, MD, PhD, Anni Nørgaard Jeppesen, MD, Christophe Henri Valdemar Duez, MD, Eldar Søreide, MD, PhD, Hans Kirkegaard, MD, DMSc, PhD The American Journal of Medicine Volume 130, Issue 1, Pages (January 2017) DOI: /j.amjmed Copyright © 2016 Elsevier Inc. Terms and Conditions
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Figure 1 Consort diagram showing the 375 patients screened for eligibility of whom 161 patients were included for analyses and of whom 63 patients had an acute myocardial infarction. The American Journal of Medicine , 37-46DOI: ( /j.amjmed ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Figure 2 Flowchart. The flowchart shows times on the x-axis and temperature on the y-axis with the intervals for biomarker sampling plotted. After 24 hours the 24-hour group is rewarmed at a rate of 0.5°C/h until 37°C (dotted line). After 48 hours the 48-hour group is rewarmed at a rate of 0.5°C/h until 37°C (dashed line). Dotted gray horizontal lines mark the target temperature zone between 32°C and 34°C. The American Journal of Medicine , 37-46DOI: ( /j.amjmed ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Figure 3 Cardiac biomarker profiles after out-of-hospital cardiac arrest. The curves of the total numbers of median values of high-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-myocardial band (CK-MB) in relation to the timing after out-of-hospital cardiac arrest. All hs-cTnT arrival values were elevated above the 99th percentile and the peak values of hs-cTnT occurred within the first 6 hours. The CK-MB arrival values were close to the upper reference limit and the peak values occurred at around 18 hours. The American Journal of Medicine , 37-46DOI: ( /j.amjmed ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Figure 4 Areas under the curve (AUC) of cardiac biomarkers, arranged according to the duration of targeted temperature management of 24 hours vs 48 hours after out-of-hospital cardiac arrest. The left part of the figure shows the high-sensitivity cardiac troponin T (hs-cTnT)AUC of all 161 out-of-hospital cardiac arrest patients, showing no significant difference between 24 hours vs 48 hours of targeted temperature management. Conversely, in the right part of the figure, creatine kinase-myocardial band (CK-MB)AUC of all the 161 out-of-hospital cardiac arrest patients shows that 48 hours is significantly higher than 24 hours of targeted temperature management. The American Journal of Medicine , 37-46DOI: ( /j.amjmed ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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