Department of Anesthesiology and Intensive Care, Ain Shams University Faculty of Medicine, Cairo, Egypt -
Department of Anesthesiology and Intensive Care, Ain Shams University Faculty of Medicine, Cairo, Egypt.
Minerva Anestesiol. 2018 Jun;84(6):720-730. doi: 10.23736/S0375-9393.18.12164-X. Epub 2018 Jan 16.
The aim of this review was to determine current evidence for the effect of therapeutic hypothermia (TH) on survival and neurological outcome in adults suffering cardiac arrest (CA).
We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE and NLM databases from 2000 to 2017 using the following terms: hypothermia, cooling, therapeutic, cardiac arrest, resuscitation, cardiopulmonary, CPR. Studies were eligible if they compared TH versus normothermic management in adult humans sustaining CA. Randomized controlled trials (RCT), pilot studies and observational trials were included.
Ten studies involving 3259 patients were included in meta-analysis. Pooling all eligible studies showed a favorable effect for TH on survival and neurological recovery. However, sensitivity analysis for RCTs showed no benefit on either outcome, while observational trials showed benefit for neurological recovery with just marginally significant benefit regarding survival. Studies including patients with shockable rhythms demonstrated benefit for both outcome measures, while those including patients with any rhythms demonstrated benefit for neurological recovery but not for survival. TH did not benefit patients with non-shockable rhythms. Trials using external cooling favored TH regarding survival and neurological outcome but those using systemic cooling with or without external cooling did not show such benefit. When the overall incidence of complications was pooled, there was a statistically significant shift in odds ratio favoring normothermic management over TH.
Evidence from RCTs suggests TH does not improve survival or neurological outcome, while observational trials favor TH over normothermia. TH may be attended with higher risk for complications.
本综述旨在确定治疗性低温（TH）对成人心脏骤停（CA）患者的生存和神经功能结局的影响的现有证据。
我们从 2000 年到 2017 年在 Cochrane 对照试验注册库、MEDLINE、EMBASE 和 NLM 数据库中使用以下术语搜索了 TH 与成人 CA 患者的常规体温管理相比的研究：低温、冷却、治疗、心脏骤停、复苏、心肺复苏（CPR）。如果研究比较了 TH 与成人 CA 患者的常规体温管理，那么这些研究就有资格入选。包括随机对照试验（RCT）、试点研究和观察性研究。
有 10 项涉及 3259 名患者的研究被纳入荟萃分析。对所有合格的研究进行汇总显示，TH 对生存和神经恢复有有利影响。然而，对 RCT 的敏感性分析显示，在任何结果上均无获益，而观察性研究则显示神经恢复有获益，只有生存获益略微显著。包括可电击节律患者的研究显示两种结果测量均有获益，而包括任何节律患者的研究则显示神经恢复有获益，但生存获益无统计学意义。TH 对非可电击节律患者无益。使用外部冷却的试验对生存和神经结局均有利于 TH，但使用全身冷却加或不加外部冷却的试验则没有显示出这种获益。当汇总整体并发症发生率时，有利于常规体温管理的优势比有统计学意义。
来自 RCT 的证据表明，TH 不能提高生存率或神经功能结局，而观察性研究则倾向于 TH 优于常规体温管理。TH 可能会带来更高的并发症风险。
