Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Acta Anaesthesiol Scand. 2012 Jan;56(1):116-23. doi: 10.1111/j.1399-6576.2011.02562.x. Epub 2011 Oct 19.
Therapeutic hypothermia in adult victims who suffer cardiac arrest following drowning has been applied in only a small number of cases. In the last 4 years, we have employed therapeutic hypothermia to decrease hypoxia-induced brain injury in these patients. The purpose of the present study was to report the results of the treatment of these patients.
This study investigated the utilisation of therapeutic hypothermia on consecutive patients with cardiac arrest because of drowning between 2005 and 2008. The study was conducted retrospectively, collecting data by reviewing medical records. Hypothermia, with a target temperature of 32-34°C, was induced for 24 h. Neurological outcomes were classified using the cerebral performance categories (CPCs). The primary outcome was neurological function at discharge.
Twenty patients were treated with therapeutic hypothermia. Four patients (20%) exhibited a favourable neurological outcome (CPC 1-2). Two patients (10%) remained in a vegetative state at discharge (CPC 4), and 14 patients (70%) died (CPC 5). The most common complications during therapeutic hypothermia were pancreatitis and rhabdomyolysis. A longer duration of advanced cardiac life support (P = 0.035), an absence of motor response to pain after 3 days (P = 0.003), an abnormal brain imaging (P = 0.005) and a lack of cortical response to somatosensory evoked potential (P = 0.008) were related to an unfavourable outcome (CPC 3-5).
The present study did not demonstrate an advantage of therapeutic hypothermia in adult cardiac arrest after drowning compared with previous studies treated with conventional therapy. Further prospective studies are needed to evaluate the effects of therapeutic hypothermia.
在仅有少数情况下，对溺水后发生心搏骤停的成年患者应用治疗性低温。在过去的 4 年中，我们已经使用治疗性低温来减轻这些患者缺氧引起的脑损伤。本研究旨在报告这些患者的治疗结果。
本研究调查了 2005 年至 2008 年间连续因溺水导致心搏骤停的患者使用治疗性低温的情况。该研究是回顾性的，通过查阅病历收集数据。低温治疗，目标温度为 32-34°C，持续 24 小时。使用脑功能分类（CPCs）对神经功能进行分类。主要结局是出院时的神经功能。
20 例患者接受了治疗性低温治疗。4 例（20%）患者出现良好的神经功能预后（CPC 1-2）。2 例（10%）患者出院时仍处于植物状态（CPC 4），14 例（70%）患者死亡（CPC 5）。治疗性低温期间最常见的并发症是胰腺炎和横纹肌溶解症。较长时间的高级心脏生命支持（P = 0.035）、3 天后对疼痛无运动反应（P = 0.003）、异常的脑成像（P = 0.005）和体感诱发电位缺乏皮质反应（P = 0.008）与不良结局（CPC 3-5）相关。
与以前使用常规治疗的研究相比，本研究未显示治疗性低温在溺水后成年人心搏骤停中的优势。需要进一步的前瞻性研究来评估治疗性低温的效果。
