Nielsen Niklas, Friberg Hans
Department of Clinical Sciences, Section of Anesthesiology and Intensive Care, Lund University, Lund, Sweden.
Curr Opin Crit Care. 2015 Jun;21(3):202-8. doi: 10.1097/MCC.0000000000000203.
Temperature management for patients comatose after cardiac arrest has been an integral component of postcardiac arrest care for the last decade. In this review, we present recent findings and discuss implications for future trials.
The two largest trials on temperature management after cardiac arrest were recently presented. The first investigated prehospital induction of hypothermia using ice-cold intravenous saline in 1364 patients. The intervention gave a significant reduction in time from return of circulation to start of hypothermia and lower body temperature on admission to hospital. There was no difference in survival or neurological function between the study groups, but there were indications of possible harm in the group that received saline. The second trial investigated two actively controlled temperatures provided in intensive care units, randomizing 950 unconscious patients suffering out-of-hospital cardiac arrest of a presumed cardiac cause to targeted temperature management at 33 and 36°C. There was no difference in survival until end of trial or neurological function at 180 days.
Prehospital hypothermia induced by cold crystalloid infusion does not benefit cardiac arrest patients. For patients treated in an intensive care unit targeting a temperature of 36°C provides similar results as targeting 33°C.
在过去十年中，心脏骤停后昏迷患者的体温管理一直是心脏骤停后护理的重要组成部分。在本综述中，我们介绍了近期的研究结果并讨论了对未来试验的影响。
最近公布了两项关于心脏骤停后体温管理的最大规模试验。第一项研究在1364例患者中调查了院前使用冰冷静脉生理盐水诱导低温的情况。该干预措施显著缩短了从恢复循环到开始低温治疗的时间，且入院时体温较低。研究组之间在生存率或神经功能方面没有差异，但接受生理盐水的组有潜在危害的迹象。第二项试验研究了重症监护病房提供的两种主动控制温度，将950例因推测为心脏原因导致院外心脏骤停的昏迷患者随机分为33°C和36°C的目标温度管理组。直到试验结束时的生存率或180天时的神经功能均无差异。
冷晶体输注诱导的院前低温对心脏骤停患者没有益处。对于在重症监护病房接受治疗的患者，目标温度为36°C与目标温度为33°C的结果相似。
