Freund Brin, Kaplan Peter W
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States, United States.
Cardiol J. 2017;24(3):324-333. doi: 10.5603/CJ.a2017.0016. Epub 2017 Feb 2.
Therapeutic hypothermia and targeted temperature management are considered standard of care in the management of patients following out-of-hospital cardiac arrests due to shockable rhythms to improve neurological outcomes. In those presenting out-of-hospital cardiac arrests associated with non-shockable rhythms, the benefit of hypothermia is less clear. In this review we try to clarify the utility of implementing a hypothermia protocol after cardiac arrests due to non-shockable rhythms.
PUBMED, Ovid, MEDLINE, EMBASE, and clinicaltrials.gov websites were searched through during October, 2016 using the terms "non shockable", "hypothermia," and "cardiac arrest." Studies were excluded if they solely evaluated in-hospital cardiac arrests, shockable rhythms, and/or pediatric patients. Data was extracted by two authors.
Forty studies were included in this review, most of which were not randomized or controlled, nor were they powered to make significant conclusions about the efficacy of hypothermia in this population. Some did evaluate specific factors that may portend to a better outcome in patients presenting with out-of-hospital cardiac arrest due to non-shockable rhythms undergoing hypothermia. Shortcomings included incorporating in-hospital cardiac arrest patients in analyses, comparing results of hypothermia in shockable versus non-shockable rhythm patients as an outcome measure, lacking standardization in cooling protocols, and short-term measures of outcomes.
It was concluded that further study is needed to characterize patients presenting nonshockable rhythms who would benefit from hypothermia to better guide its use in this population given the costs and implications of treatment and long-term care in those who survive with poor outcomes.
治疗性低温和目标温度管理被视为院外心脏骤停因可电击心律患者管理中的护理标准，以改善神经学预后。在那些出现与不可电击心律相关的院外心脏骤停患者中，低温治疗的益处尚不清楚。在本综述中，我们试图阐明在因不可电击心律导致心脏骤停后实施低温治疗方案的效用。
2016年10月期间，使用“不可电击”、“低温”和“心脏骤停”等术语在PUBMED、Ovid、MEDLINE、EMBASE和clinicaltrials.gov网站上进行搜索。如果研究仅评估院内心脏骤停、可电击心律和/或儿科患者，则将其排除。数据由两位作者提取。
本综述纳入了40项研究，其中大多数不是随机或对照研究，也没有足够的能力就低温治疗对该人群的疗效得出重大结论。一些研究确实评估了可能预示因不可电击心律导致院外心脏骤停并接受低温治疗的患者有更好预后的特定因素。缺点包括在分析中纳入了院内心脏骤停患者，将可电击与不可电击心律患者的低温治疗结果进行比较作为一项结局指标，冷却方案缺乏标准化，以及结局的短期指标。
得出的结论是，鉴于治疗成本以及对预后不良幸存者的长期护理影响，需要进一步研究以明确哪些因不可电击心律导致心脏骤停的患者将从低温治疗中获益，从而更好地指导该人群对低温治疗的使用。
