Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest- a prospective observational cohort study

INTRODUCTION: Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. Aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest.

METHODS: This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital. Patients after successful cardiopulmonary resuscitation undergoing targeted temperature management at 33°C for 24 hours with subsequent rewarming to 36°C and standardized sedation, analgesic and paralytic medication were included. Indirect calorimetry was performed 5 times within 48 h after cardiac arrest. Measurements were correlated to outcome with repeated measures ANOVA, linear and logistic regression analysis.

RESULTS: In 25 patients resting energy expenditure decreased 20 (18-27) % at 33°C compared to 36°C without differences between outcome groups (favourable vs. unfavourable: 25 (21-26) vs. 21 (16-26); p = 0.5). In contrast to protein oxidation rate (favourable vs. unfavourable: 35 (11-68) g/day vs. 39 (7-75) g/day, p = 0.8) patients with favourable outcome had a significantly higher fat oxidation rate (139 (104-171) g/day vs. 117 (70-139) g/day, p < 0.05) and a significantly lower glucose oxidation rate (30 (-34-88) g/day vs. 77 (19-138) g/day; p < 0.05) as compared to patients with unfavourable neurological outcome.

CONCLUSIONS: Targeted temperature management at 33°C after cardiac arrest reduces REE by 20% compared to 36°C. Glucose and fat oxidation rates differ significantly between patients with favourable and unfavourable neurological outcome.

TRIAL REGISTRATION: Clinicaltrials.gov NCT00500825 . Registered 11 July 2007.