Kim Min Jung, Shin Sang Do, McClellan William Marvin, McNally Bryan, Ro Young Sun, Song Kyoung Jun, Lee Eui Jung, Lee Yu Jin, Kim Joo Yeong, Hong Sung Ok, Choi Jung-Ah, Kim Young Taek
JW Lee Center for Global Medicine, Seoul National University College of Medicine, Republic of Korea.
Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea.
Resuscitation. 2014 Dec;85(12):1732-8. doi: 10.1016/j.resuscitation.2014.09.018. Epub 2014 Oct 2.
This study examined whether the extent to which out-of-hospital cardiac arrest (OHCA) patients recover neurological function after therapeutic hypothermia (TH) is augmented in specific gender, age, and primary ECG group.
A cross-sectional analysis was conducted using a nationwide database of OHCAs in Korea which was constructed from emergency medical services (EMS) run sheet and hospital medical record review between 2008 and 2012. Patients survived to admission were enrolled. Study endpoint was survival with neurological recovery (cerebral performance category 1 and 2). Main exposure was hypothermia. Gender, age group (<45, 45-65, and >65 years old) and primary ECG rhythm were considered as potential effect modifiers. Potential factors were accounted for adjustment using multivariable logistic regression.
Survival with good neurological recovery was 14.6% (9.3% in men and 17.2% in women). TH was performed in 15.5% (n=1140). Strata-specific crude analysis showed enhanced neurological recovery for women of childbearing ages compared to men counterparts (OR=4.38 (1.39, 13.74) vs. OR=1.73 (0.97, 3.10)). After adjusted for effect modifiers and covariates, the strongest effect of TH on neurological recovery was observed in men younger than 45 years of age with shockable rhythm (OR=2.00 (1.26, 3.19)), whereby no statistically significant associations were found in all women. In both genders, the magnitude of association decreased with age and having non-shockable cardiac rhythm.
TH was the strongest indicator for good neurological recovery in <45-year old men with shockable cardiac rhythm. Across all age groups, women were less likely to benefit from TH than men.
本研究旨在探讨院外心脏骤停（OHCA）患者在治疗性低温（TH）后神经功能恢复的程度在特定性别、年龄和原发性心电图分组中是否有所增强。
采用韩国全国范围内的OHCA数据库进行横断面分析，该数据库由2008年至2012年期间的紧急医疗服务（EMS）运行记录和医院病历审查构建而成。纳入存活至入院的患者。研究终点为伴有神经功能恢复的存活（脑功能分级为1级和2级）。主要暴露因素为低温治疗。性别、年龄组（<45岁、45 - 65岁和>65岁）以及原发性心电图节律被视为潜在的效应修饰因素。使用多变量逻辑回归对潜在因素进行调整。
伴有良好神经功能恢复的存活率为14.6%（男性为9.3%，女性为17.2%）。15.5%（n = 1140）的患者接受了低温治疗。分层特异性粗分析显示，育龄期女性与男性相比，神经功能恢复增强（比值比[OR]=4.38[1.39, 13.74]对OR = 1.73[0.97, 3.10]）。在对效应修饰因素和协变量进行调整后，在年龄小于45岁且心律可电击复律的男性中，观察到低温治疗对神经功能恢复的最强效应（OR = 2.00[1.26, 3.19]），而在所有女性中未发现统计学上的显著关联。在两性中，关联程度均随年龄增长和心律不可电击复律而降低。
低温治疗是年龄<45岁且心律可电击复律的男性神经功能良好恢复的最强指标。在所有年龄组中，女性从低温治疗中获益的可能性低于男性。
