Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
Resuscitation. 2018 Jul;128:11-15. doi: 10.1016/j.resuscitation.2018.04.029. Epub 2018 Apr 23.
The aim of this study was to evaluate the differential effects of mild therapeutic hypothermia (MTH) in post-cardiac arrest syndrome (PCAS) patients depending on the presence/absence of hypoxic encephalopathy (HE) in the early brain CT images obtained before the initiation of MTH.
We conducted a retrospective review of the data of a total of 129 patients with PCAS who were treated by MTH (34 °C) or normothermia treatment (NT) (35 °C or 36 °C), and had undergone brain CT examination prior to the initiation of these treatments. We divided the subjects into 4 groups, namely, the HE(-)/MTH, HE(-)/NT, HE(+)/MTH, and HE(+)/NT groups, for evaluating the interaction effect between the two variables. Then, we compared the neurological outcomes between the HE(-)/MTH and HE(-)/NT groups by multivariate logistic analysis. Good outcome was defined as a Cerebral Performance Category score of ≤2 at 30 days.
The percentages of subjects with a good outcome in the HE(-)/MTH and HE(-)/NT group were 68.9% (42/61) and 36.1% (13/36), respectively (p = .003), while those in the HE(+)/MTH and HE(+)/NT groups were lower, at 7.4% (2/27) and 20.0% (1/5), respectively (p = .410), suggesting a statistically significant interaction effect between the two variables (p = 0.002). In the HE(-) group, MTH was associated with a higher odds ratio of a good outcome as compared to NT (OR 6.80, 95% CI 1.19-38.96, p = .031).
The effect of MTH in patients with PCAS differed depending on the presence/absence of evidence of HE on the early CT images.
本研究旨在评估心脏骤停后综合征（PCAS）患者在开始亚低温治疗（MTH）前的早期脑 CT 图像中有无缺氧性脑病（HE）的情况下，MTH 的差异效应。
我们对共 129 例接受 MTH（34°C）或常温治疗（NT）（35°C 或 36°C）的 PCAS 患者的数据进行了回顾性分析，这些患者在开始这些治疗前均进行了脑 CT 检查。我们将患者分为 4 组，即 HE(-)/MTH、HE(-)/NT、HE(+)/MTH 和 HE(+)/NT 组，以评估两个变量的交互作用。然后，我们通过多变量逻辑分析比较了 HE(-)/MTH 和 HE(-)/NT 组之间的神经结局。良好的结局定义为 30 天时的脑功能预后评分≤2。
HE(-)/MTH 和 HE(-)/NT 组的良好结局发生率分别为 68.9%（42/61）和 36.1%（13/36）（p=0.003），而 HE(+)/MTH 和 HE(+)/NT 组的发生率较低，分别为 7.4%（2/27）和 20.0%（1/5）（p=0.410），表明两个变量之间存在统计学显著的交互作用（p=0.002）。在 HE(-)组中，与 NT 相比，MTH 与良好结局的更高比值相关（OR 6.80，95%CI 1.19-38.96，p=0.031）。
MTH 在 PCAS 患者中的疗效取决于早期 CT 图像上有无 HE 的证据。
