Cady Charles, Andrews Steven
Medical College of Wisconsin, Department of Emergency Medicine, Froedtert Hospital, 1-P 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
Prehosp Emerg Care. 2009 Jul-Sep;13(3):402-5. doi: 10.1080/10903120902935314.
This article is a support paper for the National Association of EMS Physicians' position paper on induced therapeutic hypothermia in resuscitated cardiac arrest patients. Induced hypothermia is one of the newest treatments aimed at increasing the dismal neurologically intact survival rate for out-of-hospital cardiac arrest patients. Two landmark studies published in 2002 by the New England Journal of Medicine led to the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care IIa recommendation of cooling unconscious adult patients with return of spontaneous circulation after out-of-hospital cardiac arrest due to ventricular fibrillation to 32 degrees C to 34 degrees C for 12 to 24 hours. Despite many limitations of those studies, the AHA also suggests that this therapy may be beneficial for patients with non-ventricular fibrillation arrests. However, the literature is lacking in answers with regard to the best methods to utilize in cooling patients. While avoiding delay in the initiation of cooling seems logical, the literature is also lacking evidence indicating the ideal time at which to implement cooling. Furthermore, it remains unclear as to which patients may benefit from induced hypothermia. Finally, the literature provides no evidence to support mandating induced hypothermia in the prehospital setting. Given limited prehospital resources, sometimes consisting of only two providers, attention first needs to be given to providing the basic care with the utmost skill. Once the basics are being delivered expertly, consideration can be given to the use of prehospital cooling for the resuscitated cardiac arrest patient in the setting of continued cooling in the hospital.
本文是一篇支持文件，是针对美国紧急医疗服务医师协会（National Association of EMS Physicians）关于对复苏成功的心脏骤停患者进行诱导治疗性低温的立场文件。诱导性低温是旨在提高院外心脏骤停患者神经功能完好生存率的最新治疗方法之一。《新英格兰医学杂志》于2002年发表的两项具有里程碑意义的研究，促使美国心脏协会（AHA）心肺复苏和急诊心血管护理指南做出IIa类推荐，即对于因室颤导致院外心脏骤停且恢复自主循环的昏迷成年患者，将体温降至32摄氏度至34摄氏度，并维持12至24小时。尽管这些研究存在许多局限性，但AHA也表明，这种疗法可能对非室颤性心脏骤停患者有益。然而，关于冷却患者的最佳方法，文献中尚无答案。虽然避免延迟开始冷却似乎合乎逻辑，但文献中也缺乏表明实施冷却的理想时间的证据。此外，哪些患者可能从诱导性低温中获益仍不清楚。最后，文献中没有证据支持在院前环境中强制进行诱导性低温治疗。鉴于有限的院前资源，有时仅由两名医护人员组成，首先需要专注于以最高的技能提供基本护理。一旦熟练地提供了基本护理后，在医院持续进行冷却的情况下，可以考虑对复苏成功的心脏骤停患者使用院前冷却。
