Tommasi Eleonora, Lazzeri Chiara, Bernardo Pasquale, Sori Andrea, Chiostri Marco, Gensini Gian F, Valente Serafina
Heart and Vessel Department, Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Cardiovasc Med (Hagerstown). 2017 Jul;18(7):459-466. doi: 10.2459/JCM.0000000000000130.
: Therapeutic hypothermia has been shown to reduce brain damage due to postcardiac arrest syndrome. Actually, there is no agreement on which is the best device to perform therapeutic hypothermia. The 'ideal' device should not only 'cool' patient until 33-34°C as fast as possible, but also maintain the target temperature and reverse the therapeutic hypothermia. For out-of-hospital cardiac arrest, there are devices that allow starting of therapeutic hypothermia on the field (prehospital hypothermia). On hospital arrival, these prehospital devices can be quickly and easily replaced with other devices more suitable for the management of therapeutic hypothermia in ICUs (in-hospital hypothermia). Some studies have compared surface and endovascular devices and found no substantial differences in neurologic outcome or survival at hospital discharge. On a clinical ground, the knowledge of the technical aspects of therapeutic hypothermia (such as characteristics of devices) is mandatory for clinicians who have to perform therapeutic hypothermia in cardiac arrest patients because the timing of therapeutic hypothermia, the choice of the device for the single patients, and avoidance of temperature fluctuation have shown to affect outcome in these patients (also in terms of reducing the incidence of complications).
治疗性低温已被证明可减少心脏骤停后综合征所致的脑损伤。实际上，对于实施治疗性低温的最佳设备尚无定论。“理想”的设备不仅应尽快将患者体温“降至”33 - 34°C，还应维持目标体温并逆转治疗性低温。对于院外心脏骤停，有一些设备可在现场启动治疗性低温（院前低温）。在患者入院时，这些院前设备可快速且轻松地更换为更适合重症监护病房（院内低温）治疗性低温管理的其他设备。一些研究比较了体表和血管内设备，发现神经学结局或出院存活率并无实质性差异。在临床上，对于必须对心脏骤停患者实施治疗性低温的临床医生而言，了解治疗性低温的技术方面（如设备特性）是必不可少的，因为治疗性低温的时机、针对单个患者的设备选择以及避免体温波动已表明会影响这些患者的结局（在减少并发症发生率方面也是如此）。
