Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
Emerg Med J. 2012 Feb;29(2):100-3. doi: 10.1136/emj.2010.105171. Epub 2011 Mar 1.
Therapeutic hypothermia has proved effective in improving outcome in patients after cardiac arrest due to ventricular fibrillation (VF). The benefit in patients with non-VF cardiac arrest is still not defined.
This prospective observational study was conducted in a university hospital setting with historical controls. Between 2002 and 2010 387 consecutive patients have been admitted to the intensive care unit (ICU) after cardiac arrest (control n=186; hypothermia n=201). Of those, in 175 patients the initial rhythm was identified as non-shockable (asystole, pulseless electrical activity) rhythm (control n=88; hypothermia n=87). Neurological outcome was assessed at ICU discharge according to the Pittsburgh cerebral performance category (CPC). A follow-up was completed for all patients after 90 days, a Kaplan-Meier analysis and Cox regression was performed.
Hypothermia treatment was not associated with significantly improved neurological outcome in patients resuscitated from non-VF cardiac arrest (CPC 1-2: hypothermia 27.59% vs control 18.20%, p=0.175). 90-Day Kaplan-Meier analysis revealed no significant benefit for the hypothermia group (log rank test p=0.82), and Cox regression showed no statistically significant improvement.
In this cohort patients undergoing hypothermia treatment after non-shockable cardiac arrest do not benefit significantly concerning neurological outcome. Hypothermia treatment needs to be evaluated in a large multicentre trial of cardiac arrest patients found initially to be in non-shockable rhythms to clarify whether cooling may also be beneficial for other rhythms than VF.
研究表明，心脏骤停后心室颤动（VF）患者的治疗性低温对改善预后有效。但非 VF 心脏骤停患者的获益尚未明确。
这是一项在大学医院进行的前瞻性观察性研究，采用历史对照。2002 年至 2010 年间，387 例心脏骤停患者（对照组 186 例，低温组 201 例）被收入重症监护病房（ICU）。其中，175 例患者的初始节律为非除颤性（无脉电活动、停搏）节律（对照组 88 例，低温组 87 例）。根据匹兹堡脑功能预后评分（CPC）评估 ICU 出院时的神经功能预后。对所有患者进行了 90 天的随访，进行了 Kaplan-Meier 分析和 Cox 回归分析。
低温治疗与非 VF 心脏骤停患者的神经功能预后改善无关（CPC 1-2：低温组 27.59% vs 对照组 18.20%，p=0.175）。90 天 Kaplan-Meier 分析显示低温组无显著获益（对数秩检验 p=0.82），Cox 回归也未显示统计学意义上的改善。
在本队列中，行低温治疗的非除颤性心脏骤停患者神经功能预后无显著改善。需要在大型多中心心脏骤停患者试验中进一步评估低温治疗，以明确冷却治疗是否对除 VF 以外的其他节律也有益。
