Targeted temperature management after cardiac arrest: real-world outcomes from a tertiary ICU in Türkiye

Abstract

Aim Targeted temperature management (TTM) is a core component of post-cardiac arrest care. Its effectiveness in improving survival and neurological outcomes remains debated, especially in resource-limited settings such as Türkiye. This study aimed to evaluate the impact of TTM on 28-day mortality, lactate clearance, and neurological recovery in cardiac arrest patients admitted to an intensive care unit (ICU). Methods This retrospective cohort study included 61 adult patients who achieved return of spontaneous circulation (ROSC) following cardiac arrest and were admitted to the ICU of a tertiary care hospital in Türkiye. After 1:4 propensity score matching based on demographic and clinical variables, 45 patients (9 in the TTM group and 36 in the control group) were included in the analysis. The primary outcome was 28-day mortality. Secondary outcomes included lactate clearance, change in Glasgow Coma Scale (GCS), and Cerebral Performance Category (CPC) score at discharge. Results There was no statistically significant difference in 28-day mortality between groups (44.4% vs. 69.4%, P = .261). However, TTM was associated with significantly greater lactate clearance (54.2% vs. 39.7%, P = .038) and improved CPC scores (P = .042). No significant difference was observed in the change in GCS. Post-hoc power analysis for mortality was 18%. Conclusion While TTM did not significantly reduce short-term mortality, it was associated with improved metabolic and neurological outcomes. These findings emphasize the importance of considering functional recovery endpoints and suggest that even in middle-income settings, TTM can be beneficial when properly implemented.