Ambulance Victoria, Monash University, The Alfred Hospital, Melbourne, Australia.
Crit Care Med. 2012 Mar;40(3):747-53. doi: 10.1097/CCM.0b013e3182377038.
To evaluate the effects on temperature and outcome at hospital discharge of a pre-hospital rapid infusion of large volume, ice-cold intravenous Hartmann's solution in patients with out-of-hospital cardiac arrest and an initial cardiac rhythm of asystole or pulseless electrical activity.
Prospective, randomized, controlled clinical trial.
Pre-hospital emergency medical service and 12 critical care units in Melbourne, Australia.
One hundred and sixty three patients who had been resuscitated from cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity.
: Patients were randomized to either pre-hospital cooling using a rapid infusion of up to two litres ice-cold Hartmann's solution (82 patients) or cooling after hospital admission (81 patients). The planned duration of therapeutic hypothermia (32 °C-34 °C) in both groups was 24 hrs.
Patients allocated to pre-hospital cooling received a median of 1500 ml of ice-cold fluid. This resulted in a mean decrease in core temperature of 1.4 °C compared with 0.2 °C in hospital cooled patients (p < .001). The time to therapeutic hypothermia (<34 °C) was 3.2 hrs in the pre-hospital cooled group compared with 4.8 hrs in the hospital cooled group (p = .0328). Both groups received a mean of 15 hrs cooling in the hospital and only 7 patients in each group were cooled for 24 hrs. Overall, there was no difference in outcomes at hospital discharge with favorable outcome (discharge from hospital to home or rehabilitation) in 10 of 82 (12%) in the pre-hospital cooled patients, compared with 7 of 81 (9%) in the hospital cooled patients (p = .50). In the patients with a cardiac cause of the arrest, 8 of 47 patients (17%) who received pre-hospital cooling had a favorable outcome at hospital discharge compared with 3 of 43 (7%) in the hospital cooled group (p = .146).
In adults who have been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity, pre-hospital cooling using a rapid infusion of large-volume, ice cold intravenous Hartmann's solution decreases core temperature at hospital arrival and decreases the time to therapeutic hypothermia. In patients with a cardiac cause of the arrest, this treatment may increase the rate of favorable outcome at hospital discharge. Further larger studies should evaluate the effects of pre-hospital cooling when the initial cardiac rhythm is asystole or pulseless electrical activity, particularly in patients with a cardiac cause of the arrest.
评估院前快速输注大量冰冷静脉哈特曼氏溶液对院外心脏骤停且初始心搏骤停或无脉性电活动的患者体温和出院结局的影响。
前瞻性、随机、对照临床试验。
澳大利亚墨尔本的院前急救医疗服务和 12 个重症监护病房。
163 名因初始心搏骤停或无脉性电活动而接受心脏骤停复苏的患者。
患者随机分为院前冷却组（82 例）或入院后冷却组（81 例）。两组均计划进行 24 小时的治疗性低温（32°C-34°C）。
接受院前冷却的患者平均接受了 1500 毫升冰冷液体。与入院后冷却的患者相比，这导致核心温度平均下降 1.4°C（p<.001）。与入院后冷却组相比，院前冷却组达到治疗性低温（<34°C）的时间为 3.2 小时（p=0.0328）。两组在医院内平均冷却 15 小时，只有每组 7 名患者冷却 24 小时。总体而言，出院时的结局无差异，院前冷却组 82 例中有 10 例（12%）患者出院后恢复良好（出院回家或康复），而入院后冷却组 81 例中有 7 例（9%）（p=0.50）。在因心脏原因导致骤停的患者中，47 例接受院前冷却的患者中有 8 例（17%）出院时预后良好，而 43 例入院后冷却的患者中仅有 3 例（7%）（p=0.146）。
在因初始心搏骤停或无脉性电活动而从院外心脏骤停中复苏的成年人中，使用快速输注大量冰冷静脉哈特曼氏溶液进行院前冷却可降低入院时的核心温度，并缩短达到治疗性低温的时间。对于因心脏原因导致骤停的患者，这种治疗方法可能会增加出院时预后良好的比例。应进一步进行更大规模的研究，评估初始心搏骤停或无脉性电活动时院前冷却的效果，特别是在因心脏原因导致骤停的患者中。
