Grejs Anders Morten, Gjedsted Jakob, Thygesen Kristian, Lassen Jens Flensted, Rasmussen Bodil Steen, Jeppesen Anni Nørgaard, Duez Christophe Henri Valdemar, Søreide Eldar, Kirkegaard Hans
Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
Am J Med. 2017 Jan;130(1):37-46. doi: 10.1016/j.amjmed.2016.06.047. Epub 2016 Jul 29.
The aim of this study is to evaluate the extent of myocardial injury by cardiac biomarkers during prolonged targeted temperature management of 24 hours vs 48 hours after out-of-hospital cardiac arrest.
This randomized Scandinavian multicenter study compares the extent of myocardial injury quantified by area under the curve (AUC) of cardiac biomarkers during prolonged targeted temperature management at 33°C ± 1°C of 24 hours and 48 hours, respectively. Through a period of 2.5 years, 161 comatose out-of-hospital cardiac arrest patients were randomized to targeted temperature management for 24 hours (n = 77) or 48 hours (n = 84). The AUC was calculated using both high-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-myocardial band (CK-MB) that were based upon measurements of these biomarkers every 6 hours upon admission until 96 hours after reaching target temperature.
The median hs-cTnT of 33,827 ng/L/h (interquartile range [IQR] 11,366-117,690) of targeted temperature management at 24 hours did not differ significantly from that of 28,973 ng/L/h (IQR 10,656-163,655) at 48 hours. In contrast, the median CK-MB of 1829 μg/L/h (IQR 800-6799) during targeted temperature management at 24 hours was significantly lower than that of 2428 μg/L/h (IQR 1163-10,906) within targeted temperature management at 48 hours, P <.05.
This study of comatose out-of-hospital cardiac arrest survivors showed no difference between the extents of myocardial injury estimated by hs-cTnT of prolonged targeted temperature management of 48 hours vs 24 hours, although the CK-MB was significantly higher during 48 hours vs 24 hours. Hence, it seems unlikely that the duration of targeted temperature management has a beneficial effect on the extent of myocardial injury after out-of-hospital cardiac arrest, and may even have a worsening effect.
本研究旨在评估院外心脏骤停后进行24小时与48小时的延长目标温度管理期间，心脏生物标志物对心肌损伤的评估程度。
这项随机的斯堪的纳维亚多中心研究比较了在33°C±1°C下分别进行24小时和48小时延长目标温度管理期间，通过心脏生物标志物曲线下面积（AUC）量化的心肌损伤程度。在2.5年的时间里，161名院外心脏骤停昏迷患者被随机分为接受24小时（n = 77）或48小时（n = 84）的目标温度管理。使用高敏心肌肌钙蛋白T（hs-cTnT）和肌酸激酶同工酶（CK-MB）计算AUC，这些指标基于入院后每6小时对这些生物标志物的测量，直至达到目标温度后96小时。
24小时目标温度管理的hs-cTnT中位数为33,827 ng/L/h（四分位间距[IQR] 11,366 - 117,690），与48小时的28,973 ng/L/h（IQR 10,656 - 163,655）相比，差异无统计学意义。相比之下，24小时目标温度管理期间CK-MB的中位数为1829 μg/L/h（IQR 800 - 6799），显著低于48小时目标温度管理期间的2428 μg/L/h（IQR 1163 - 10,906），P <.05。
这项针对院外心脏骤停昏迷幸存者的研究表明，48小时与24小时延长目标温度管理通过hs-cTnT评估的心肌损伤程度没有差异，尽管48小时期间的CK-MB显著高于24小时。因此，目标温度管理的持续时间似乎不太可能对院外心脏骤停后的心肌损伤程度产生有益影响，甚至可能产生恶化作用。
