Emergency Medical Center, Kagawa University Hospital, Miki, Japan.
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan.
Crit Care Med. 2018 Sep;46(9):e881-e888. doi: 10.1097/CCM.0000000000003254.
Bradycardia during therapeutic hypothermia has been reported to be a predictor of favorable neurologic outcomes in out-of-hospital cardiac arrests. However, bradycardia occurrence rate may be influenced by the target body temperature. During therapeutic hypothermia, as part of the normal physiologic response, heart rate decreases in the cooling phase and increases during the rewarming phase. We hypothesized that increased heart rate during the rewarming phase is another predictor of favorable neurologic outcomes. To address this hypothesis, the study aimed to examine the association between heart rate response during the rewarming phase and neurologic outcomes in patients having return of spontaneous circulation after out-of-hospital cardiac arrest.
A secondary analysis of the Japanese Population-based Utstein style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia registry, which was a multicenter prospective cohort study.
Fourteen hospitals throughout Japan.
Patients suffering from out-of-hospital cardiac arrest who received therapeutic hypothermia after the return of spontaneous circulation from 2005 to 2011.
None.
This study enrolled 452 out-of-hospital cardiac arrest patients, of which 354 were analyzed, and 80.2% survived to hospital discharge, of which 57.3% had a good neurologic outcome. Heart rate response was calculated using heart rate data recorded during therapeutic hypothermia in the abovementioned registry. Heart rate response in the rewarming phase (heart rate response-rewarming) was calculated as follows: (heart rate [post rewarming]-heart rate [pre rewarming])/heart rate (pre rewarming) × 100. The primary outcome was an unfavorable neurologic outcome at hospital discharge, that is, a Cerebral Performance Category of 3-5. Multivariable logistic regression analysis was performed to determine the association between heart rate response-rewarming and unfavorable neurologic outcomes. Multivariable logistic regression analysis showed that heart rate response-rewarming was independently associated with unfavorable outcomes (odds ratio [per 10% change], 0.86; 95% CI, 0.78-0.96; p = 0.004).
Increased heart rate in the approximately 48-hour rewarming phase during therapeutic hypothermia was significantly associated with and was an independent predictor of favorable neurologic outcomes during out-of-hospital cardiac arrest.
在治疗性低温期间发生的心动过缓已被报道为院外心脏骤停后神经功能结局良好的预测因素。然而，心动过缓的发生率可能受到目标体温的影响。在治疗性低温期间，作为正常生理反应的一部分，心率在冷却阶段下降，在复温阶段增加。我们假设复温阶段心率增加是神经功能结局良好的另一个预测因素。为了验证这一假设，本研究旨在检查院外心脏骤停后自主循环恢复患者复温期间心率反应与神经功能结局之间的关系。
这是一项日本人群为基础的 Utstein 风格研究的二次分析，该研究进行了除颤和基础/高级生命支持教育和实施-低温注册，这是一项多中心前瞻性队列研究。
日本的 14 家医院。
2005 年至 2011 年期间，从自主循环恢复后接受治疗性低温的院外心脏骤停患者。
无。
本研究纳入了 452 例院外心脏骤停患者，其中 354 例进行了分析，80.2%的患者存活至出院，其中 57.3%的患者神经功能良好。上述注册中心记录的治疗性低温期间的心率数据用于计算心率反应。复温阶段的心率反应（心率反应-复温）计算如下：（复温后的心率-复温前的心率）/复温前的心率×100。主要结局为出院时神经功能不良，即脑功能状态分类 3-5 级。进行多变量逻辑回归分析以确定心率反应-复温与不良神经结局之间的关系。多变量逻辑回归分析显示，心率反应-复温与不良结局独立相关（每 10%变化的优势比[per 10% change]，0.86；95%置信区间，0.78-0.96；p=0.004）。
在治疗性低温期间约 48 小时的复温阶段，心率增加与院外心脏骤停后神经功能结局良好显著相关，是神经功能结局良好的独立预测因素。
