Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-3117, USA.
Resuscitation. 2010 Apr;81(4):398-403. doi: 10.1016/j.resuscitation.2009.12.016. Epub 2010 Jan 18.
Mild therapeautic hypothermia (MTH) has been associated with cardiac dysrhythmias, coagulopathy and infection. After restoration of spontaneous circulation (ROSC), many cardiac arrest patients undergo percutaneous coronary intervention (PCI). The safety and feasibility of combined MTH and PCI remains unclear. This is the first study to evaluate whether PCI increases cardiac risk or compromises functional outcomes in comatose cardiac arrest patients who undergo MTH.
Ninety patients within a 6-h window following cardiac arrest and ROSC were included. Twenty subjects (23%) who underwent PCI following MTH induction were compared to 70 control patients who underwent MTH without PCI. The primary endpoint was the rate of dysrhythmias; secondary endpoints were time-to-MTH induction, rates of adverse events (dysrhythmia, coagulopathy, hypotension and infection) and mortality.
Patients who underwent PCI plus MTH suffered no statistical increase in adverse events (P=.054). No significant difference was found in the rates of dysrhythmias (P=.27), infection (P=.90), coagulopathy (P=.90) or hypotension (P=.08). The PCI plus MTH group achieved similar neurological outcomes (modified Rankin Scale (mRS) <or=3 (P=.42) and survival rates (P=.40). PCI did not affect the speed of MTH induction; the target temperature was reached in both groups without a significant time difference (P=.29).
Percutaneous coronary intervention seems to be feasible when combined with MTH, and is not associated with increased cardiac or neurological risk.
轻度治疗性低温（MTH）与心律失常、凝血障碍和感染有关。在自主循环恢复（ROSC）后，许多心脏骤停患者接受经皮冠状动脉介入治疗（PCI）。MTH 与 PCI 联合应用的安全性和可行性尚不清楚。这是第一项评估昏迷心脏骤停患者接受 MTH 后 PCI 是否会增加心脏风险或影响功能结局的研究。
纳入心脏骤停和 ROSC 后 6 小时内的 90 例患者。将 20 例（23%）在 MTH 诱导后接受 PCI 的患者与 70 例未行 PCI 的 MTH 对照患者进行比较。主要终点是心律失常发生率；次要终点是 MTH 诱导时间、不良事件（心律失常、凝血障碍、低血压和感染）发生率和死亡率。
接受 PCI 加 MTH 的患者不良事件发生率无统计学增加（P=.054）。心律失常发生率（P=.27）、感染率（P=.90）、凝血障碍发生率（P=.90）或低血压发生率（P=.08）无显著差异。PCI 加 MTH 组的神经功能结局相似（改良 Rankin 量表（mRS）<or=3（P=.42）和生存率（P=.40）。PCI 并未影响 MTH 诱导的速度；两组均未达到目标温度，无显著时间差异（P=.29）。
当与 MTH 联合应用时，经皮冠状动脉介入治疗似乎是可行的，并且不会增加心脏或神经风险。
