Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
Resuscitation. 2013 Aug;84(8):1056-61. doi: 10.1016/j.resuscitation.2012.11.003. Epub 2012 Nov 12.
Therapeutic hypothermia, also known as targeted temperature management (TTM), improves clinical outcomes in patients resuscitated from cardiac arrest. Hyperthermia after discontinuation of active temperature management ("rebound pyrexia") has been observed, but its incidence and association with clinical outcomes is poorly described. We hypothesized that rebound pyrexia is common after rewarming in post-arrest patients and is associated with poor neurologic outcomes.
Retrospective multicenter US clinical registry study of post-cardiac arrest patients treated with TTM at 11 hospitals between 5/2005 and 10/2011. We assessed the incidence of rebound pyrexia (defined as temperature >38°C) in post-arrest patients treated with TTM and subsequent clinical outcomes of survival to discharge and "good" neurologic outcome at discharge, defined as cerebral performance category (CPC) 1-2.
In this cohort of 236 post-arrest patients treated with TTM, mean age was 58.1 ± 15.7 y and 106/236 (45%) were female. Of patients who survived at least 24h after TTM discontinuation (n=167), post-rewarming pyrexia occurred in 69/167 (41%), with a median maximum temperature of 38.7 (IQR 38.3-38.9). There were no significant differences between patients experiencing any pyrexia and those without pyrexia regarding either survival to discharge (37/69 (54%) v 51/98 (52%), p=0.88) or good neurologic outcomes (26/37 (70%) v 42/51 (82%), p=0.21). We compared patients with marked pyrexia (greater than the median pyrexia of 38.7°C) versus those who experienced no pyrexia or milder pyrexia (below the median) and found that survival to discharge was not statistically significant (40% v 56% p=0.16). However, marked pyrexia was associated with a significantly lower proportion of CPC 1-2 survivors (58% v 80% p=0.04).
Rebound pyrexia occurred in 41% of TTM-treated post-arrest patients, and was not associated with lower survival to discharge or worsened neurologic outcomes. However, among patients with pyrexia, higher maximum temperature (>38.7°C) was associated with worse neurologic outcomes among survivors to hospital discharge.
治疗性低温，也称为目标温度管理（TTM），可改善心搏骤停后患者的临床转归。在主动体温管理停止后会出现体温反跳性升高（“反弹性发热”），但其发生率和与临床结果的关系尚未得到充分描述。我们假设在心脏骤停后患者复温后体温反跳性升高很常见，并且与不良神经结局相关。
对 2005 年 5 月至 2011 年 10 月期间在 11 家医院接受 TTM 治疗的心脏骤停后患者进行回顾性多中心美国临床注册研究。我们评估了接受 TTM 治疗的心脏骤停后患者中体温反跳性升高（定义为体温>38°C）的发生率，以及随后的临床结局，包括出院时的生存和出院时的“良好”神经结局，定义为脑功能状态分类（CPC）1-2。
在接受 TTM 治疗的 236 例心脏骤停后患者中，平均年龄为 58.1±15.7 岁，106/236（45%）为女性。在至少 24 小时 TTM 停止后存活的患者中（n=167），69/167（41%）出现复温后发热，最高温度中位数为 38.7（IQR 38.3-38.9）。在出现任何发热的患者和未出现发热的患者之间，无论出院时的生存情况（37/69（54%）与 51/98（52%），p=0.88）还是良好的神经结局（26/37（70%）与 42/51（82%），p=0.21）均无显著差异。我们比较了发热明显（大于 38.7°C 的中位发热）的患者与未发热或发热较轻（低于中位发热）的患者，发现出院时的生存无统计学意义（40%与 56%，p=0.16）。然而，明显的发热与 CPC 1-2 幸存者的比例显著降低相关（58%与 80%，p=0.04）。
TTM 治疗的心脏骤停后患者中 41%出现体温反跳性升高，与出院时的生存率或神经结局恶化无关。然而，在发热患者中，最高温度（>38.7°C）与存活患者出院时的神经结局恶化相关。
