Maze Ronnen, Le May Michel R, Froeschl Michael, Hazra Samir K, Wells Philip S, Osborne Christina, Labinaz Marino, Hibbert Benjamin, So Derek Y F
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, ON, Canada.
Resuscitation. 2014 Oct;85(10):1354-8. doi: 10.1016/j.resuscitation.2014.05.029. Epub 2014 Jun 27.
Therapeutic hypothermia improves neurologic outcome and survival in patients following out-of-hospital cardiac arrest (OHCA). Endovascular cooling devices are commonly used to rapidly achieve and maintain hypothermia. The use of these devices may be associated with catheter related thrombosis. The objective of this study was to determine the risk of catheter related thrombosis associated with the use of an endovascular cooling catheter in patients referred for therapeutic hypothermia following OHCA.
We conducted a retrospective cohort study on consecutive patients, referred for therapeutic hypothermia following OHCA, between February 2012 and May 2013. Of 80 patients initially treated with therapeutic hypothermia, 61 completed the cooling protocol using an endovascular cooling device. The primary outcome was catheter related thrombosis defined as evidence of thrombus in the inferior vena cava, deep vein thrombosis or pulmonary embolism during the index hospitalization. We further evaluated the incidence of the primary outcome between patients on dose adjusted intravenous unfractionated heparin compared to those on a subcutaneous prophylactic regimen alone. Catheter related thrombosis was observed in 9/61 (14.7%), with nine events in the prophylaxis group compared to none in the full dose unfractionated heparin group (22.0% vs. 0.0%, p=0.02).
The use of endovascular catheters for induction of therapeutic hypothermia is associated with a high rate of catheter related thrombosis. This risk appears to be abrogated with dose adjusted unfractionated heparin infusion.
治疗性低温可改善院外心脏骤停（OHCA）患者的神经功能预后并提高生存率。血管内降温装置常用于快速实现并维持低温状态。使用这些装置可能与导管相关血栓形成有关。本研究的目的是确定在OHCA后接受治疗性低温的患者中，使用血管内降温导管相关的导管相关血栓形成风险。
我们对2012年2月至2013年5月期间因OHCA后接受治疗性低温的连续患者进行了一项回顾性队列研究。在最初接受治疗性低温治疗的80例患者中，61例使用血管内降温装置完成了降温方案。主要结局是导管相关血栓形成，定义为在本次住院期间下腔静脉血栓、深静脉血栓或肺栓塞的证据。我们进一步评估了剂量调整静脉普通肝素治疗的患者与仅接受皮下预防方案的患者之间主要结局的发生率。61例患者中有9例（14.7%）观察到导管相关血栓形成，预防组有9例事件，而全剂量普通肝素组无事件发生（22.0%对0.0%，p=0.02）。
使用血管内导管诱导治疗性低温与导管相关血栓形成的高发生率相关。调整剂量的普通肝素输注似乎可消除这种风险。
