Martinell Louise, Herlitz Johan, Karlsson Thomas, Nielsen Niklas, Rylander Christian
Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
The Center for Pre-hospital Research in Western Sweden, University College of Borås and Sahlgrenska University Hospital, Gothenburg, Sweden.
Am J Emerg Med. 2017 Nov;35(11):1595-1600. doi: 10.1016/j.ajem.2017.04.071. Epub 2017 Apr 27.
Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015.
Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed.
Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71-5.29; p<0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83-2.15; p=0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88-2.22; p=0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive.
Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders.
基于两项临床试验，轻度低温诱导（MIH）于2003年在瑞典被引入用于心脏骤停后护理。这项回顾性研究评估了2003年至2015年瑞典一个社区中其与院外心脏骤停（OHCA）后30天生存率的关联。
在3680例OHCA患者中，1100例在自主循环恢复后住院，871例仍昏迷的患者被纳入分析。院前数据从瑞典心肺复苏登记处提取，院内数据从临床记录中提取。对完整数据集进行倾向评分分析，并采用多重填补法进行多变量逻辑回归以弥补数据缺失。
未经调整的30天生存率为23.5%；在386/871例（44%）接受MIH治疗的患者中为37%，在485/871例（56%）未接受MIH治疗的患者中为13%。与未接受MIH治疗的患者相比，接受MIH治疗的患者30天生存的未调整优势比（OR）为3.79（95%CI 2.71 - 5.29；p<0.0001）。使用分层倾向评分分析并进一步调整院内因素后，与未接受MIH治疗的患者相比，接受MIH治疗的患者30天生存率无显著差异；OR为1.33（95%CI 0.83 - 2.15；p = 0.24）。使用多重填补法处理缺失数据得到的调整后OR相似，为1.40（95%CI 0.88 - 2.22；p = 0.15）。82%存活出院的患者在出院时神经功能良好。
在调整潜在混杂因素后，OHCA后仍昏迷的患者接受MIH治疗与30天生存率增加无显著关联。
