Resuscitation 84 (2013) 1056–1061 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Clinical paper Pyrexia and neurologic outcomes after therapeutic hypothermia for cardiac arrest  Marion Leary a,b,1 , Anne V. Grossestreuer a,1 , Stephen Iannacone a,1 , Mariana Gonzalez a,1 , Frances S. Shofer a,1 , Clare Povey c,1 , Gary Wendell c,1 , Susan E. Archer d,1 , David F. Gaieski a,1 , Benjamin S. Abella a,b,∗,1 a Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States b Section of Pulmonary Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States c Medical Intensive Care Unit, Crozer-Chester Medical Center, Upland, PA, United States d Department of Critical Care, Frederick Memorial Hospital, Frederick, MD, United States article info Article history: Received 14 June 2012 Received in revised form 24 October 2012 Accepted 5 November 2012 Keywords: Cardiac arrest Targeted temperature management Therapeutic hypothermia Sudden death Adverse effects Pyrexia abstract Objective: Therapeutic hypothermia, also known as targeted temperature management (TTM), improves clinical outcomes in patients resuscitated from cardiac arrest. Hyperthermia after discontinuation of active temperature management (“rebound pyrexia”) has been observed, but its incidence and association with clinical outcomes is poorly described. We hypothesized that rebound pyrexia is common after rewarming in post-arrest patients and is associated with poor neurologic outcomes. Methods: Retrospective multicenter US clinical registry study of post-cardiac arrest patients treated with TTM at 11 hospitals between 5/2005 and 10/2011. We assessed the incidence of rebound pyrexia (defined as temperature >38 ◦ C) in post-arrest patients treated with TTM and subsequent clinical outcomes of sur- vival to discharge and “good” neurologic outcome at discharge, defined as cerebral performance category (CPC) 1–2. Results: In this cohort of 236 post-arrest patients treated with TTM, mean age was 58.1 ± 15.7 y and 106/236 (45%) were female. Of patients who survived at least 24 h after TTM discontinuation (n = 167), post-rewarming pyrexia occurred in 69/167 (41%), with a median maximum temperature of 38.7 (IQR 38.3–38.9). There were no significant differences between patients experiencing any pyrexia and those without pyrexia regarding either survival to discharge (37/69 (54%) v 51/98 (52%), p = 0.88) or good neurologic outcomes (26/37 (70%) v 42/51 (82%), p = 0.21). We compared patients with marked pyrexia (greater than the median pyrexia of 38.7 ◦ C) versus those who experienced no pyrexia or milder pyrexia (below the median) and found that survival to discharge was not statistically significant (40% v 56% p = 0.16). However, marked pyrexia was associated with a significantly lower proportion of CPC 1–2 survivors (58% v 80% p = 0.04). Conclusions: Rebound pyrexia occurred in 41% of TTM-treated post-arrest patients, and was not asso- ciated with lower survival to discharge or worsened neurologic outcomes. However, among patients with pyrexia, higher maximum temperature (>38.7 ◦ C) was associated with worse neurologic outcomes among survivors to hospital discharge. © 2012 Elsevier Ireland Ltd. All rights reserved.  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.11.003. ∗ Corresponding author at: University of Pennsylvania, Department of Emergency Medicine, Center for Resuscitation Science, 3400 Spruce Street, Ground Ravdin, Philadelphia, PA 19104, United States. Tel.: +1 215 279 3452; fax: +1 215 662 3953. E-mail address: benjamin.abella@uphs.upenn.edu (B.S. Abella). 1 On behalf of the PATH investigators (see Appendix A). 1. Introduction Therapeutic hypothermia improves both survival and neuro- logic outcome when initiated after resuscitation from cardiac arrest. 1–4 Contemporary protocols for therapeutic hypothermia, known more broadly as therapeutic temperature management (TTM), consist of a cooling phase, a maintenance phase in which temperature is held at 32–34 ◦ C, and a rewarming phase in which normothermia is restored and active temperature control is removed. Subsequent to rewarming, “rebound pyrexia” has been observed, with temperature elevations >38 ◦ C within 24 h of the 0300-9572/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2012.11.003