Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Resuscitation. 2017 Dec;121:187-194. doi: 10.1016/j.resuscitation.2017.10.002. Epub 2017 Oct 5.
Targeted temperature management (TTM) improves survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA), but is delivered inconsistently and often with delay.
To determine if prehospital cooling by paramedics leads to higher rates of 'successful TTM', defined as achieving a target temperature of 32-34°C within 6h of hospital arrival.
Pragmatic RCT comparing prehospital cooling (surface ice packs, cold saline infusion, wristband reminders) initiated 5min after return of spontaneous circulation (ROSC) versus usual resuscitation and transport. The primary outcome was rate of 'successful TTM'; secondary outcomes were rates of applying TTM in hospital, survival with good neurological outcome, pulmonary edema in emergency department, and re-arrest during transport.
585 patients were randomized to receive prehospital cooling (n=279) or control (n=306). Prehospital cooling did not increase rates of 'successful TTM' (30% vs 25%; RR, 1.17; 95% confidence interval [CI] 0.91-1.52; p=0.22), but increased rates of applying TTM in hospital (68% vs 56%; RR, 1.21; 95%CI 1.07-1.37; p=0.003). Survival with good neurological outcome (29% vs 26%; RR, 1.13, 95%CI 0.87-1.47; p=0.37) was similar. Prehospital cooling was not associated with re-arrest during transport (7.5% vs 8.2%; RR, 0.94; 95%CI 0.54-1.63; p=0.83) but was associated with decreased incidence of pulmonary edema in emergency department (12% vs 18%; RR, 0.66; 95%CI 0.44-0.99; p=0.04).
Prehospital cooling initiated 5min after ROSC did not increase rates of achieving a target temperature of 32-34°C within 6h of hospital arrival but was safe and increased application of TTM in hospital.
目标温度管理（TTM）可提高院外心脏骤停（OHCA）后存活并具有良好神经功能结局的几率，但 TTM 的实施不一致，且往往存在延迟。
确定院前急救员实施院前降温是否会提高“成功 TTM”的比例，“成功 TTM”定义为在入院后 6 小时内达到 32-34°C 的目标温度。
对比较院前降温（表面冰袋、冷生理盐水输注、腕带提醒）与常规复苏和转运的实用随机对照试验进行回顾性分析。主要结局为“成功 TTM”的比例；次要结局为医院内 TTM 的应用率、存活并具有良好神经功能结局的比例、急诊科肺水肿的发生率以及转运过程中的再停搏率。
共 585 例患者随机分为接受院前降温组（n=279）或对照组（n=306）。院前降温并未提高“成功 TTM”的比例（30% vs 25%；RR，1.17；95%置信区间 [CI] 0.91-1.52；p=0.22），但增加了医院内 TTM 的应用率（68% vs 56%；RR，1.21；95%CI 1.07-1.37；p=0.003）。存活并具有良好神经功能结局的比例（29% vs 26%；RR，1.13，95%CI 0.87-1.47；p=0.37）相似。院前降温与转运过程中的再停搏率无关（7.5% vs 8.2%；RR，0.94；95%CI 0.54-1.63；p=0.83），但与急诊科肺水肿发生率降低有关（12% vs 18%；RR，0.66；95%CI 0.44-0.99；p=0.04）。
ROSC 后 5 分钟开始的院前降温并未提高入院后 6 小时内达到 32-34°C 目标温度的比例，但安全且增加了医院内 TTM 的应用。
