Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany.
Clin Res Cardiol. 2013 Aug;102(8):607-14. doi: 10.1007/s00392-013-0572-3. Epub 2013 May 5.
Mild induced hypothermia (MIH) is indicated for comatose survivors of sudden cardiac arrest (SCA) to improve clinical outcome. In this study, we compared the efficacy of two different cooling devices for temperature management in SCA survivors.
Between April 2008 and August 2009, 80 patients after survived in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) were included in this prospective, randomized, single center study. Hypothermia was induced after randomization by either invasive Coolgard(®) cooling or non-invasive ArcticSun(®) surface cooling at 33.0 °C core body temperature for 24 h followed by active rewarming. The primary endpoint was defined as the efficacy of both cooling systems, measured by neuron-specific enolase (NSE) levels as a surrogate parameter for brain damage. Secondary efficacy endpoints were the clinical and neurological outcome, time to start of cooling and reaching the target temperature, target temperature-maintenance and hypothermia-associated complications.
NSE at 72 h did not differ significantly between the 2 groups with 16.5 ng/ml, interquartile range 11.8-46.5 in surface-cooled patients versus 19.0 ng/ml, interquartile range 11.0-42.0 in invasive-cooled patients, p = 0.99. Neurological and clinical outcome was similar in both groups. Target temperature of 33.0 °C was maintained more stable in the invasive group (33.0 versus 32.7 °C, p < 0.001). Bleeding complications were more frequent with invasive cooling (n = 17 [43.6 %] versus n = 7 [17.9 %]; p = 0.03).
Invasive cooling has advantages with respect to temperature management over surface cooling; however, did not result in different outcome as measured by NSE release in SCA survivors. Bleeding complications were more frequently encountered by invasive cooling.
轻度诱导性低温（MIH）适用于心脏骤停（SCA）后昏迷的幸存者，以改善临床结果。在这项研究中，我们比较了两种不同的冷却设备在 SCA 幸存者体温管理中的疗效。
在 2008 年 4 月至 2009 年 8 月期间，这项前瞻性、随机、单中心研究纳入了 80 例院内（IHCA）和院外心脏骤停（OHCA）后存活的患者。随机分组后，通过侵入性 Coolgard（®）冷却或非侵入性 ArcticSun（®）表面冷却将体温降至 33.0°C 核心体温 24 小时，然后进行主动复温。主要终点是通过神经元特异性烯醇化酶（NSE）水平作为脑损伤的替代参数来衡量两种冷却系统的疗效。次要疗效终点是临床和神经结局、开始冷却和达到目标温度的时间、目标温度维持和与低温相关的并发症。
72 小时时，两组之间的 NSE 水平无显著差异，表面冷却组为 16.5ng/ml，四分位间距 11.8-46.5，侵入性冷却组为 19.0ng/ml，四分位间距 11.0-42.0，p=0.99。两组之间的神经和临床结局相似。目标体温 33.0°C 在侵入性组更稳定（33.0 与 32.7°C，p<0.001）。侵入性冷却更常发生出血并发症（17 例[43.6%]与 7 例[17.9%]；p=0.03）。
与表面冷却相比，侵入性冷却在体温管理方面具有优势；然而，在 SCA 幸存者中，通过 NSE 释放测量，结果并无差异。侵入性冷却更常发生出血并发症。
