Erath J W, Hodrius J, Bushoven P, Fichtlscherer S, Zeiher A M, Seeger F H, Honold J
Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland.
Med Klin Intensivmed Notfmed. 2017 Sep;112(6):519-526. doi: 10.1007/s00063-016-0228-y. Epub 2016 Nov 2.
Targeted temperature management (TTM) represents an effective therapy to improve neurologic outcome in patients who survive an out-of-hospital cardiac arrest (OHCA). First publications about this therapy reported a higher incidence of infections in patients who underwent TTM induced by external cooling devices. Whether intravascular cooling devices are also associated with an increased infection rate has not been investigated so far.
In a single center retrospective study, the incidence of early onset pneumonia (EOP) in OHCA patients with or without intravascular TTM at 33 °C target temperature for 24 h who survived at least 24 h after admission was analyzed.
A total of 68 OHCA survivors (mean age 65 ± 15 years) were included in this analysis. The most common causes of OHCA were myocardial infarction (35 %), primary ventricular fibrillation (24 %), asystole (15 %), and pulmonary embolism (7 %). Of those, 32 patients (48 %) received TTM. The overall incidence of EOP was 38 %. Incidence of EOP did not differ significantly between groups, was more frequent in the group without TTM (42 % vs. 34 %, p = 0.57) and had no impact on mortality (hazard ratio = 1.02; 95 % confidence interval 0.25-4.16; p = 0.97).
Intravascular TTM at 33 °C with a cooling catheter is not associated with more infective complications in OHCA patients. This finding underscores the safety of TTM.
目标温度管理(TTM)是一种改善院外心脏骤停(OHCA)存活患者神经功能结局的有效疗法。关于该疗法的首批出版物报道,接受外部冷却设备诱导的TTM的患者感染发生率较高。血管内冷却设备是否也与感染率增加相关,目前尚未进行研究。
在一项单中心回顾性研究中,分析了目标温度为33°C持续24小时、入院后至少存活24小时的接受或未接受血管内TTM的OHCA患者的早发性肺炎(EOP)发生率。
本分析共纳入68例OHCA存活者(平均年龄65±15岁)。OHCA最常见的病因是心肌梗死(35%)、原发性心室颤动(24%)、心脏停搏(15%)和肺栓塞(7%)。其中,32例患者(48%)接受了TTM。EOP的总体发生率为38%。两组之间EOP的发生率无显著差异,未接受TTM的组中更常见(42%对34%,p = 0.57),且对死亡率无影响(风险比 = 1.02;95%置信区间0.25 - 4.16;p = 0.97)。
使用冷却导管在33°C进行血管内TTM与OHCA患者更多的感染并发症无关。这一发现强调了TTM的安全性。