东亚多中心研究：悬挂诱导心搏骤停目标温度管理
EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest.
机构信息
From the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland (C.H.H., B.E.H., T.M.S., D.M.S.); University of Michigan Ann Arbor, Michigan (C.H.H., I.N.C.); University of Kentucky, Lexington, Kentucky (M.D., A.C.B.); Los Angeles County/University of Southern California Medical Center, Los Angeles, California (A.A., K.I.); Oregon Health & Science University, Portland, Oregon (H.E.H., C.E.); University of California Davis Medical Center, Davis, California (J.G., E.M.T.); University of Washington/Harborview Medical Center, Seattle, Washington (N.J.J., D.C.); Vanderbilt University Medical Center, Nashville, Tennessee (M.F.M., M.B.P.); Loma Linda University Medical Center, Loma Linda, California (K.R.O., C.C.); WakeMed Health & Hospitals, Raleigh, North Carolina (P.O.U., M.F.); Geisinger Medical Center, Danville, Pennsylvania (J.L.W., K.A.Y.); Marshfield Clinic, Marshfield, Wisconsin (D.C.C., D.J.G.); University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.W., C.C.); University of Colorado Hospital, Aurora, Colorado (S.M.P., M.G.); Brigham Women's Hospital, Boston, Massachusetts (I.P.A., R.R.S.); San Francisco General Hospital/University of California San Francisco, San Francisco, California (D.Y.M., B.D.); Harbor UCLA Medical Center, Torrance, California (D.Y.K., L.S.).
出版信息
J Trauma Acute Care Surg. 2018 Jul;85(1):37-47. doi: 10.1097/TA.0000000000001945.
BACKGROUND
We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study.
METHODS
We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome.
RESULTS
A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy.
CONCLUSION
Cardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models.
LEVEL OF EVIDENCE
Therapeutic study, level IV; prognostic study, level III.
背景
我们通过东部创伤外科学会（EAST）多中心回顾性研究，旨在确定自杀性悬垂的结果以及目标温度管理（TTM）对悬垂性心搏骤停（CA）的影响。
方法
我们分析了 1992 年 1 月至 2015 年 12 月期间的悬垂患者数据和 TTM 变量。格拉斯哥预后评分（GOS）为 1 或 2 被认为是良好的神经学结局，而 GOS 为 3 或 4 被认为是较差的结局。分类和回归树递归分区用于开发生存和神经学结局的多变量预测模型。
结果
本研究共分析了来自 17 个中心的 692 例悬垂患者。他们的总生存率为 77%，CA 生存率为 28.6%。CA 患者的疾病严重程度和结局明显比非 CA 患者差。在 175 例存活至入院的 CA 患者中，81 例（46.3%）接受了 CA 后 TTM。未调整的 TTM CA 患者（24.7%比 39.4%，p<0.05）和良好的神经学结局（19.8%比 37.2%，p<0.05）均差于非 TTM CA 患者。然而，当对入院格拉斯哥昏迷量表评分 3 至 8 分的患者进行亚组分析时，TTM 和非 TTM CA 生存（23.8%比 30.0%，p=0.37）和良好的神经学结局（18.8%比 28.7%，p=0.14）之间的差异无统计学意义。参与中心之间的 TTM 实施和 CA 后管理存在差异。分类和回归树模型确定了悬垂和 TTM 患者良好和不良结局的预测变量，准确性很高。
结论
CA 悬垂患者的结局比非 CA 患者差。未调整的 TTM CA 患者的生存率和神经学结局均比非 TTM 患者差。这些发现可能是由于疾病严重程度更高、TTM 实施情况不同以及 CA 后管理存在差异所致。未来的前瞻性研究需要确定 TTM 对悬垂结局的影响，并验证我们的分类和回归树模型。
证据水平
治疗研究，IV 级；预后研究，III 级。
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