Division of Cardiology, Hartford Hospital, Hartford, CT, United States.
Resuscitation. 2012 Feb;83(2):202-7. doi: 10.1016/j.resuscitation.2011.08.005. Epub 2011 Aug 22.
Therapeutic hypothermia improves neurologic outcomes in patients resuscitated from cardiac arrest due to ventricular fibrillation. However, its role in patients with cardiac arrest due to non-shockable rhythms (pulseless electrical activity (PEA) and asystole) is unclear. We hypothesized that therapeutic hypothermia favorably impacts neurologic outcome and survival in patients resuscitated from cardiac arrest due to non-shockable rhythms.
Retrospectively collected data on consecutive adult patients admitted to Hartford Hospital from 1/1/2004 to 11/1/2010 who survived a cardiac arrest due to PEA or asystole were analyzed. Patients who underwent therapeutic hypothermia (1/1/2007-11/1/2010) formed the hypothermia group while patients admitted prior to the institution of therapeutic hypothermia (1/1/2004-1/1/2007) at Hartford Hospital formed the control group. The primary end-point was measured using the Pittsburgh cerebral performance category (CPC) scale and patients were assessed for a good (CPC 1 and 2) or poor (CPC 3-5) neurological outcome prior to discharge from hospital. A secondary end-point was measured as survival at discharge from hospital.
Of 100 post-cardiac arrest patients included in the study, 15/52 (29%) patients in the hypothermia group had a good neurologic outcome as compared to 5/43 (10%) patients in the control group (P=0.021). On multivariate analysis, the odds ratio for good neurologic outcome and survival at discharge from the hospital with therapeutic hypothermia as compared to control were 4.35 (95% CI 1.10-17.24, P=0.04) and 5.65 (CI 1.66-19.23, P=0.006) respectively.
Therapeutic hypothermia is associated with favorable neurologic outcome and survival in patients resuscitated after cardiac arrest due to non-shockable rhythms.
治疗性低温可改善因心室颤动而复苏的心脏骤停患者的神经功能预后。然而，其在非除颤性节律（无脉电活动[PEA]和心搏停止）所致心脏骤停患者中的作用尚不清楚。我们假设治疗性低温可改善因非除颤性节律导致心脏骤停后复苏患者的神经功能预后和存活率。
回顾性分析 2004 年 1 月 1 日至 2010 年 11 月 1 日期间连续收治的因 PEA 或心搏停止而发生心脏骤停并存活的成年患者的临床资料。接受治疗性低温（2007 年 1 月 1 日至 2010 年 11 月 1 日）的患者为低温组，而在哈特福德医院接受治疗性低温前（2004 年 1 月 1 日至 2007 年 1 月 1 日）入院的患者为对照组。主要终点采用匹兹堡脑功能预后评分（CPC）量表进行评估，患者在出院前根据神经功能预后评估为良好（CPC 1 和 2）或不良（CPC 3-5）。次要终点为出院时的存活率。
在纳入研究的 100 例心脏骤停后患者中，低温组 15/52（29%）患者的神经功能预后良好，而对照组 5/43（10%）患者的神经功能预后良好（P=0.021）。多变量分析显示，与对照组相比，接受治疗性低温治疗的患者出院时神经功能良好和存活的优势比分别为 4.35（95%CI 1.10-17.24，P=0.04）和 5.65（CI 1.66-19.23，P=0.006）。
治疗性低温与非除颤性节律所致心脏骤停后复苏患者的良好神经功能预后和存活率相关。
