Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, 7th Floor Dazian Building, New York, NY 10003, United States.
Resuscitation. 2011 Jan;82(1):15-20. doi: 10.1016/j.resuscitation.2010.08.020. Epub 2010 Nov 2.
The benefits of inducing mild therapeutic hypothermia (MTH) in cardiac arrest patients are well established. Timing and speed of induction have been related to improved outcomes in several animal trials and one human study. We report the results of an easily implemented, rapid, safe, and low-cost protocol for the induction of MTH.
All in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients admitted to an intensive care unit meeting inclusion criteria were cooled using a combination modality of rapid, cold saline infusion (CSI), evaporative surface cooling, and ice water gastric lavage. Cooling tasks were performed with a primary emphasis on speed. The main endpoints were the time intervals between return of spontaneous circulation (ROSC), initiation of hypothermia (IH), and achievement of target temperature (TT).
65 patients underwent MTH during a 3-year period. All patients reached target temperature. Median ROSC-TT was 134min. Median ROSC-IH was 68min. Median IH-TT was 60min. IH-TT cooling rate was 2.6°C/h. Complications were similar to that of other large trials. 31% of this mixed population of IHCA and OHCA patients recovered to a Pittsburgh cerebral performance score (CPC) of 1 or 2.
A protocol using a combination of core and surface cooling modalities was rapid, safe, and low cost in achieving MTH. The cooling rate of 2.6°C/h was superior to most published protocols. This method uses readily available equipment and reduces the need for costly commercial devices.
诱导轻度治疗性低体温（MTH）对心脏骤停患者的益处已得到充分证实。在几项动物试验和一项人体研究中，诱导的时机和速度与改善结果有关。我们报告了一种易于实施、快速、安全且低成本的 MTH 诱导方案的结果。
所有符合纳入标准的入住重症监护病房的院内心脏骤停（IHCA）和院外心脏骤停（OHCA）患者均采用快速冷盐水输注（CSI）、蒸发表面冷却和冰水胃灌洗相结合的方式进行冷却。冷却任务主要侧重于速度。主要终点是自主循环恢复（ROSC）、开始低温（IH）和达到目标温度（TT）之间的时间间隔。
在 3 年期间，有 65 名患者接受了 MTH。所有患者均达到目标温度。中位 ROSC-TT 为 134 分钟。中位 ROSC-IH 为 68 分钟。中位 IH-TT 为 60 分钟。IH-TT 冷却速率为 2.6°C/h。并发症与其他大型试验相似。在这个 IHCA 和 OHCA 混合人群中，有 31%的患者恢复到匹兹堡脑功能表现评分（CPC）为 1 或 2。
使用核心和表面冷却方式组合的方案在实现 MTH 方面快速、安全且成本低。2.6°C/h 的冷却速率优于大多数已发表的方案。该方法使用现成的设备，减少了对昂贵商业设备的需求。
