{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:54:27Z","timestamp":1755795267927,"version":"3.44.0"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,11,9]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Targeted temperature management (TTM) is a recommended therapy for postcardiac arrest patients. Hyperthermia worsened the patient outcome, and overcooling increased the incidence of complications; therefore, a high-quality TTM is required. The target temperature tended to be modified worldwide after the TTM trial in 2013. Our institute modified the target temperature to 35\u00b0C in 2017. This study aimed to compare the conventional and modified protocols, assess the relationship between target temperature deviation and patient outcomes, and identify the factors influencing temperature deviation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This single-centre, retrospective, observational study included adult out-of-hospital cardiac arrest patients who underwent TTM between April 2013 and October 2019. We compared the conventional and modified protocol groups to evaluate the difference in the background characteristics and details on TTM. Subsequently, we assessed the relationship of deviation (&gt;\u00b10.5\u00b0C, &gt;37\u00b0C, or&lt;33\u00b0C) rates from the target temperature with mortality and neurological outcomes. We assessed the factors that influenced the deviation from the target temperature.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Temperature deviation was frequently observed in the conventional protocol group (p=0.012), and the modified protocol group required higher doses of neuromuscular blocking agents (NMBAs) during TTM (p=0.016). Other background data, completion of protocol, incidence of complications, mortality and rate of favourable neurological outcomes were not significantly different. The performance rate of TTM was significantly higher in the modified group than in the conventional protocol group (p&lt;0.001). Temperature deviation did not have an impact on the outcomes. Age, sex, body surface area, NMBA doses and type of cooling device were the factors influencing temperature deviation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A target temperature of 35\u00b0C might be acceptable and easily attainable if shivering of the patients was well controlled using NMBAs. Temperature deviation did not have an impact on outcomes. The identified factors influencing deviation from target temperature might be useful for ensuring a high-quality TTM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002459","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T23:45:44Z","timestamp":1702597544000},"page":"e002459","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing deviation from target temperature during targeted temperature management in postcardiac arrest patients"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6503-8427","authenticated-orcid":false,"given":"Kanae","family":"Ochiai","sequence":"first","affiliation":[{"name":"Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan"},{"name":"Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9674-1369","authenticated-orcid":false,"given":"Yasuhiro","family":"Otomo","sequence":"additional","affiliation":[{"name":"Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan"},{"name":"National Disaster Medical Center, Tachikawa, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,12,14]]},"reference":[{"key":"2025081710591646000_10.2.e002459.1","doi-asserted-by":"crossref","first-page":"A80","DOI":"10.1016\/j.resuscitation.2020.09.012","article-title":"Adult advanced life support: 2020 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations","volume":"156","author":"Soar","year":"2020","journal-title":"Resuscitation"},{"key":"2025081710591646000_10.2.e002459.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000916"},{"key":"2025081710591646000_10.2.e002459.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310519"},{"key":"2025081710591646000_10.2.e002459.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-015-0104-6","article-title":"\u201cChanges in cardiac arrest patients\u2019 temperature management after the 2013 \u201cTTM\u201d trial: results from an international survey\u201d","volume":"6","author":"Deye","year":"2016","journal-title":"Ann Intensive Care"},{"key":"2025081710591646000_10.2.e002459.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2017.01.016"},{"key":"2025081710591646000_10.2.e002459.6","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003339"},{"key":"2025081710591646000_10.2.e002459.7","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2018.4511","article-title":"Temporal trends in the use of therapeutic hypothermia for out-of-hospital cardiac arrest","volume":"1","author":"Bradley","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2025081710591646000_10.2.e002459.8","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.resuscitation.2019.08.029","article-title":"Long-term survival in out-of-hospital cardiac arrest patients treated with targeted temperature control at 33\u202f\u00b0C or 36\u202f\u00b0C: A national Registry study","volume":"143","author":"Abazi","year":"2019","journal-title":"Resuscitation"},{"key":"2025081710591646000_10.2.e002459.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1906661"},{"key":"2025081710591646000_10.2.e002459.10","doi-asserted-by":"publisher","DOI":"10.1385\/NCC:1:2:171"},{"key":"2025081710591646000_10.2.e002459.11","doi-asserted-by":"crossref","unstructured":"Polderman KH . 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