Wolfrum Sebastian, Radke Peter W, Pischon Tobias, Willich Stefan N, Schunkert Heribert, Kurowski Volkhard
Medical Clinic II, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Resuscitation. 2007 Feb;72(2):207-13. doi: 10.1016/j.resuscitation.2006.06.033. Epub 2006 Nov 13.
To investigate the implementation of mild therapeutic hypothermia (MTH) after cardiac arrest into clinical practice.
A structured evaluation questionnaire was sent to all German hospitals registered to have ICUs; 58% completed the survey. A total of 93 ICUs (24%) reported to use MTH. Of those, 93% started MTH in patients after out-of-hospital resuscitation with observed ventricular fibrillation and 72% when other initial rhythms were observed. Only a minority of ICUs initiate MTH in patients after cardiac arrest with cardiogenic shock (28%), whereas 48% regarded cardiogenic shock as a contra-indication for MTH. On average, target temperature was 33.1+/-0.6 degrees C and duration of cooling 22.9+/-4.9 h. Many centres used economically priced cold packs (82%) and cold infusions (80%) for cooling. The majority of the ICUs considered infection, hypotension and bleeding as relevant complications of hypothermia which was of therapeutic relevance in less than 25% of the cases.
MTH is underused in German ICUs. Centres which use MTH widely follow the recommendations of ILCOR with respect to the indication and timing of cooling. In hospitals that use MTH the technique is considered to be safe and inexpensive. More efforts are needed to promote this therapeutic option and hypothermia since MTH has now been included into European advanced cardiovascular life support protocols.
研究心脏骤停后轻度治疗性低温（MTH）在临床实践中的应用情况。
向所有登记设有重症监护病房（ICU）的德国医院发送了一份结构化评估问卷；58%的医院完成了调查。共有93个ICU（24%）报告使用MTH。其中，93%在院外复苏后观察到室颤的患者中启动MTH，72%在观察到其他初始心律时启动。只有少数ICU在心脏骤停合并心源性休克的患者中启动MTH（28%），而48%将心源性休克视为MTH的禁忌证。平均目标温度为33.1±0.6℃，降温持续时间为22.9±4.9小时。许多中心使用价格经济的冷敷袋（82%）和冷灌注液（80%）进行降温。大多数ICU认为感染、低血压和出血是低温的相关并发症，在不到25%的病例中具有治疗相关性。
MTH在德国ICU中的使用不足。广泛使用MTH的中心在降温的适应证和时机方面遵循国际复苏联合会（ILCOR）的建议。在使用MTH的医院中，该技术被认为是安全且经济的。由于MTH现已被纳入欧洲高级心血管生命支持协议，因此需要做出更多努力来推广这种治疗选择和低温治疗。
