Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea.
Am J Emerg Med. 2011 Feb;29(2):148-54. doi: 10.1016/j.ajem.2009.08.021. Epub 2010 Mar 26.
According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation, unconscious adult patients with a return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours. However, it is unclear which target temperature is more adequate. In this study, we prospectively evaluated the outcome and adverse effects following 3 target temperatures (32°C, 33°C, and 34°C) during therapeutic hypothermia with ROSC after out-of-hospital cardiac arrest.
This is a prospective study of patients with ROSC (>24 hours) after out-of-hospital cardiac arrest who were admitted to the intensive care unit in a tertiary hospital and underwent therapeutic hypothermia during a 22-month period between March 2007 and December 2008.
Sixty-two patients were included. The number of male patients was 44. The mean (SD) ages of the patients was 54.61 (2.002) years. There were 13, 22, and 28 patients who were enrolled in the target temperatures (32°C, 33°C, and 34°C, respectively). There were no significant differences after each target temperature with respect to mortality and neurologic outcomes. Regarding adverse effects, hypotension during the maintenance of therapeutic hypothermia significantly increased when the target temperature was 32°C (P = .023). Based on multivariate analysis, hypotension during the maintenance of therapeutic hypothermia was increased more than 6 times at 32°C compared with 33°C (odds ratio, 6.800; 95% confidence interval, 1.428-32.373).
When performing therapeutic hypothermia in patients with ROSC after an out-of-hospital cardiac arrest, the target temperature would be set to 33°C or 34°C, rather than 32°C. Further multicenter randomized controlled studies may be needed in the future.
根据 2005 年美国心脏协会心肺复苏指南，院外心脏骤停后自主循环恢复（ROSC）的无意识成年患者应将体温降至 32°C 至 34°C 并维持 12 至 24 小时。然而，尚不清楚哪种目标温度更合适。在这项研究中，我们前瞻性评估了院外心脏骤停后 ROSC 患者接受治疗性低温治疗时的 3 种目标温度（32°C、33°C 和 34°C）的结局和不良反应。
这是一项前瞻性研究，纳入了 2007 年 3 月至 2008 年 12 月期间在一家三级医院重症监护病房住院并接受治疗性低温治疗的 ROSC（>24 小时）院外心脏骤停患者。
共纳入 62 例患者，男性 44 例，平均（SD）年龄 54.61（2.002）岁。分别有 13、22 和 28 例患者被纳入目标温度（32°C、33°C 和 34°C）组。在每个目标温度组之间，死亡率和神经学结局均无显著差异。关于不良反应，在维持治疗性低温时，当目标温度为 32°C 时低血压的发生率显著升高（P=.023）。基于多变量分析，与 33°C 相比，在维持治疗性低温时 32°C 时低血压的发生率增加了 6 倍以上（比值比，6.800；95%置信区间，1.428-32.373）。
在院外心脏骤停后 ROSC 患者中进行治疗性低温治疗时，目标温度应设定为 33°C 或 34°C，而不是 32°C。未来可能需要进行更多的多中心随机对照研究。
