Effectiveness and safety of early enteral nutrition for patients who received targeted temperature management after out-of-hospital cardiac arrest
Open accessAbstract
Aim Early enteral nutrition (EN) is recommended for critically ill patients; however, few reports have examined early EN for patients who received targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). We investigated the effectiveness and safety of early EN for patients who received TTM after OHCA. Methods We used a nationwide Japanese administrative database to identify OHCA patients who received TTM from April 2008 to March 2017. The primary outcome was 30-day mortality; secondary outcomes were incidences of all-cause infection, pneumonia, and intestinal ischemia. Results Of the 1932 OHCA patients who received TTM, 1682 met the inclusion criteria. Of these, 294 received early EN within 2 days from the initiation of TTM and 266 propensity-score matched pairs were generated. Cox regression analyses revealed no significant difference in 30-day mortality between groups (hazard ratio (HR): 0.90; 95% confidence interval (95% CI): 0.65-1.25). There was no significant difference in the incidence of all-cause infection (odds ratio (OR): 0.98; 95% CI: 0.66-1.46) or pneumonia (OR: 1.02; 95% CI: 0.68-1.55). Subgroup analyses of patients with a low body mass index (BMI; kg/m2) (< 18.5) revealed a significant decrease of 30-day mortality in the early EN group (HR: 0.30; 95% CI: 0.092-0.97) but no significant difference among patients with a BMI ≥ 18.5 (HR: 1.01; 95% CI: 0.72-1.43). Conclusion Among patients who received TTM after OHCA, there was no significant association between early EN and 30-day mortality; however, early EN could be beneficial for patients with a low BMI.
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Newer data demonstrated no difference in complications with early enteral nutrition (<48 hours) even during targeted temperature management.
“newer data demonstrated no difference in complications with early EN (<48 hours) even during targeted temperature management.19,174–177”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [175]
The Study population and outcomes section defines early enteral nutrition as starting within two days of TTM, and the Results report no significant difference in pneumonia or all-cause infection between groups. But the broader claim of no difference in complications goes beyond those findings: one early-EN patient developed intestinal ischemia, and the Discussion says the study could not estimate its association with early EN. The copy provides no page number for these passages. (LLM, conf=0.84)
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Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Kim, G. W., Roh, Y.-I., Cha, K.-C., Hwang, S. O., Han, J. H., & Jung, W. J. (2022) · Acute and Critical Care · doi:10.4266/acc.2022.00696 · Cited by 4 · see citing works
Reply to: immortal time bias in an observational study on enteral nutrition
Gutierrez, A., & Bartos, J. A. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.07.032 · Cited by 1 · see citing works
- Authors
- Joo, W. J., Ide, K., Kawasaki, Y., Takeda, C., Seki, T., Usui, T., & Kawakami, K.
- Affiliations
- Kyoto University (JP)
- Chiba University Hospital (JP)
- University of Tokyo Hospital (JP)
- Corresponding author
- Kawakami, Koji
- ORCID
- Venue
- Resuscitation
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 135
- Pages
- 191-196
- ISSN
- 0300-9572 (ISSN-L)
- OpenAlex
- W2908793694
- Cited by
- 25
- References
- 3
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 8 · 2022: 4 · 2021: 3 · 2020: 2
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-03-01)
- Open access
- green
- hdl.handle.net
- Locations
- Resuscitation (publishedVersion)
- PubMed (publishedVersion)
- Kyoto University Research Information Repository (Kyoto University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- early enteral nutrition, targeted temperature management, out-of-hospital cardiac arrest, 30-day mortality, infection, pneumonia, intestinal ischemia, body mass index, post-cardiac arrest syndrome
- MeSH terms
- Enteral Nutrition, Female, Humans, Hypothermia, Induced, Japan, Male, Middle Aged, Outcome and Process Assessment, Health Care, Risk Factors, Body Mass Index, Incidence, Databases, Factual, Cardiopulmonary Resuscitation, Malnutrition, Out-of-Hospital Cardiac Arrest, Early Medical Intervention, Time-to-Treatment
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