Temporal trends and hospital variation in post-resuscitation fever for in-hospital cardiac arrest

Background

A goal of post-resuscitation care among patients successfully resuscitated from in-hospital cardiac arrest (IHCA) is fever avoidance. However, the incidence of post-resuscitation fever after the initial therapeutic hypothermia trials in 2002 and after the Targeted Temperature Management (TTM) trial in 2013 is unknown.

Methods

Within the U.S. Get With The Guidelines-Resuscitation registry for IHCA, we identified adults with return of spontaneous circulation (ROSC). Patients with sepsis or COVID-19 were excluded. Temporal trends in post-resuscitation fever (≥100 °F) within 24 h of ROSC following the initial hypothermia trials (2005–2013) and after the TTM trial (2014–2022) were described. Hospital-level variation in post-resuscitation fever rates was assessed for the latter period.

Results

Among 41,155 patients, mean age was 64.8 ± 15.0 years, 40.0 % were women, and 68.6 % were White. Overall, 11,745 (28.5 %) had post-resuscitation fever. Annual rates of post-resuscitation fever decreased from 39.1 % in 2005 to 29.0 % in 2013 (P for trend <0.001), and modestly from as high as 29.0 % in 2015 to 26.0 % in 2022 (P for trend of 0.003). Among 127 hospitals since the publication of the TTM trial, the rate of post-resuscitation fever varied widely from 3.4 % to 46.0 %, with a median OR of 1.81 (95 % CI: 1.72–1.91), indicating that, on average, the odds of post-resuscitation fever for patients with identical characteristics from two randomly selected hospitals varied by 81 %.

Conclusions

Post-resuscitation fever rates have decreased among patients with IHCA after the initial therapeutic hypothermia trials, but substantial hospital-level variation remains. Our findings highlight potential opportunities for improvement in post-resuscitation care.