Department of Emergency Medicine, Seoul National University College of Medicine, South Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea.
Resuscitation. 2015 Apr;89:129-36. doi: 10.1016/j.resuscitation.2015.01.024. Epub 2015 Jan 28.
Mild therapeutic hypothermia (MTH) has been known to be associated with good neurological recovery after out-of-hospital cardiac arrest (OHCA). Prehospital return of spontaneous circulation (P-ROSC) is associated with better hospital outcomes than ROSC at emergency department (ED-ROSC). The study aims to examine the association between MTH by location of ROSC and good neurological recovery after OHCA.
Adult OHCA cases with presumed cardiac etiology who survived to hospital admission were collected from a nationwide cardiac registry between 2008 and 2013. MTH was defined as a case receiving hypothermia procedure regardless of procedure method. Primary outcome was good neurological recovery with cerebral performance category score of 1 and 2. Multivariable logistic regression analysis was performed adjusting for potential confounders with an interaction term between MTH and location of ROSC to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs).
Among 11,158 patients survived to admission, good neurological recovery was 23.6% (399/1691) in MTH vs. 15.0% (1400/9316) in non-MTH (p<0.001), and 58.2% (1074/1864) in P-ROSC vs. 7.9% (725/9161) in ED-ROSC (p<0.001). There was a significant association between MTH and good neurological recovery (AOR=1.32, 95% CI=1.11-1.57). In the interaction model, AOR of MTH and interaction effect with P-ROSC and ED-ROSC was 0.78 (0.58-2.70) and 1.68 (1.34-1.98), respectively.
MTH was significantly associated with good neurological recovery among OHCA survivors. In the interaction model, MTH showed significant benefits in patient group with ROSC at ED, not in P-ROSC group.
已知轻度治疗性低温（MTH）与院外心脏骤停（OHCA）后神经功能恢复良好相关。院前自主循环恢复（P-ROSC）与急诊科自主循环恢复（ED-ROSC）相比，与更好的医院结局相关。本研究旨在探讨 ROSC 部位与 OHCA 后神经功能良好恢复之间的关系。
从 2008 年至 2013 年，从全国性心脏注册中心收集了患有推定心源性病因并存活至入院的成年 OHCA 病例。MTH 的定义为接受低温治疗的病例，无论治疗方法如何。主要结局是脑功能状态评分 1 分和 2 分的良好神经功能恢复。多变量逻辑回归分析调整了潜在混杂因素，并在 MTH 和 ROSC 部位之间计算调整后的比值比（AOR）和 95%置信区间（CI）。
在 11158 例存活至入院的患者中，MTH 组良好神经功能恢复的比例为 23.6%（399/1691），而非 MTH 组为 15.0%（1400/9316）（p<0.001），P-ROSC 组为 58.2%（1074/1864），ED-ROSC 组为 7.9%（725/9161）（p<0.001）。MTH 与良好神经功能恢复之间存在显著关联（AOR=1.32，95%CI=1.11-1.57）。在交互模型中，MTH 的 AOR 和与 P-ROSC 和 ED-ROSC 的交互效应分别为 0.78（0.58-2.70）和 1.68（1.34-1.98）。
MTH 与 OHCA 幸存者的良好神经功能恢复显著相关。在交互模型中，MTH 在 ROSC 在 ED 的患者群体中显示出显著的益处，而不在 P-ROSC 群体中。
