Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan.
Am J Emerg Med. 2012 Nov;30(9):1838-44. doi: 10.1016/j.ajem.2012.03.024. Epub 2012 Jul 15.
Detailed procedures for optimal therapeutic hypothermia (TH) have yet to be established. We examined how duration of well-controlled core temperature within the first 24 hours after cardiac arrests (CA) correlated with neurological outcomes of successfully resuscitated out-of-hospital CA (OHCA) patients.
OHCA patients who survived over 24 hours and treated with TH were included. Core temperature was measured every hour. Physicians intended to maintain temperature at 33 °C ± 1 °C for 24 hours. Cerebral performance categories (CPC) of patients at 6 months were recorded and patients were retrospectively divided into favorable (CPC1,2) and poor (CPC3-5) neurological outcome groups. Total time while the core temperature reached to 33 °C ± 1 °C within the first 24 hours after CA was measured and this duration was defined that of well-controlled temperature. receiver-operating characteristic analysis was performed on duration of well-controlled temperature to select the optimal cutoff value. Neurological outcome predictors were investigated by logistic regression analysis.
Fifty-six patients were included. Optimal cutoff value of duration of well-controlled temperature was 18 hours. Ratio of male sex, witnessed by emergency medical service (EMS) personnel, first electrocardiogram as shockable, and duration of well-controlled core temperature ≥ 18 h of favorable neurological outcome group (n = 21) were significantly larger than that of poor neurological outcome group (n = 35). Logistic regression analysis identified "witnessed by EMS", "performed bystander CPR," and "the duration ≥ 18 h" as independent predictors of favorable neurological outcome.
TH maintained at target temperature of 33 °C ± 1 °C over 18 hours independently correlated with favorable neurological outcome. Therefore, stable core temperature control may improve neurological outcome of successfully resuscitated OHCA.
详细的治疗性低温（TH）程序尚未建立。我们研究了心脏骤停（CA）后 24 小时内核心温度得到良好控制的时间与成功复苏的院外 CA（OHCA）患者的神经结局之间的相关性。
纳入存活超过 24 小时并接受 TH 治疗的 OHCA 患者。每小时测量核心温度。医生旨在将温度维持在 33°C±1°C 24 小时。记录患者 6 个月时的脑功能分类（CPC），并将患者回顾性分为神经结局良好（CPC1、2）和不良（CPC3-5）组。测量 CA 后 24 小时内核心温度达到 33°C±1°C 的总时间，并将此时间定义为温度得到良好控制的时间。对良好控制温度的持续时间进行接收者操作特征分析，以选择最佳截断值。通过逻辑回归分析探讨神经结局的预测因素。
共纳入 56 例患者。良好控制温度持续时间的最佳截断值为 18 小时。神经结局良好组（n=21）中男性比例、由急救医疗服务（EMS）人员目击、首次心电图为可除颤型、以及良好控制核心温度的持续时间≥18 小时的比例明显大于神经结局不良组（n=35）。逻辑回归分析确定“由 EMS 目击”、“进行旁观者心肺复苏”和“持续时间≥18 小时”为神经结局良好的独立预测因素。
将目标温度维持在 33°C±1°C 超过 18 小时与神经结局良好独立相关。因此，稳定的核心温度控制可能改善成功复苏的 OHCA 患者的神经结局。
