Resuscitation. 2016 Jan;98:97-104. doi: 10.1016/j.resuscitation.2015.09.396. Epub 2015 Oct 9.
For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.
十多年来，轻度诱导性低温（32°C-34°C）一直是院外心脏骤停复苏后持续昏迷且初始为可除颤节律患者的标准治疗方法，这一方法也被推广应用于初始为不可除颤节律的心脏骤停幸存者和院内心脏骤停患者。2002 年发表的两项随机试验报告称，轻度诱导性低温可带来生存和神经获益。最近的一项随机试验报告称，在接受目标温度管理治疗的患者中，无论是 33°C 还是 36°C，治疗结果相似。针对这些新数据，国际复苏联合会高级生命支持任务组进行了系统评价，以评估 3 个关键问题：（1）是否应在心脏骤停后昏迷患者中使用轻度诱导性低温（或某种形式的目标温度管理）？（2）如果使用，干预的理想时机是什么？（3）如果使用，干预的理想持续时间是多久？该任务组使用推荐评估、制定与评估分级方法评估和总结证据，并就科学声明和治疗建议达成共识。该任务组建议对初始为可除颤节律的院外心脏骤停患者使用目标温度管理，将体温维持在 32°C-36°C 之间至少 24 小时。对初始为不可除颤节律的院外心脏骤停患者和院内心脏骤停患者也提出了类似的建议。该任务组不建议院前使用快速输注大量冷静脉液体进行冷却。该文件提供了其他特定建议。
