Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Resuscitation. 2018 Dec;133:180-186. doi: 10.1016/j.resuscitation.2018.08.019. Epub 2018 Aug 22.
Recent studies suggest that a 48-h therapeutic hypothermia protocol does not improve outcomes in paediatric out-of-hospital cardiac arrest survivors. The aim of this study was to evaluate the effect of 72-h therapeutic hypothermia at 33 °C compared to normothermia at 35.5 °C-37.5 °C on outcomes and the incidence of adverse events in paediatric asphyxial out-of-hospital cardiac arrest survivors.
We conducted this retrospective cohort study at a tertiary paediatric intensive care unit between January 2010 and June 2017. All children from 1 month to 18 years of age with asphyxial out-of-hospital cardiac arrest and a history of at least 3 min of chest compressions who survived for 12 h or more after the return of circulation were eligible.
Sixty-four patients met the eligibility criteria for the study. Forty-nine (76.6%) of the 64 children were male, and the mean age was 4.86+/-5.26 years. Twenty-four (37.5%) of the children had underlying disorders. The overall 1-month survival rate was 43.2%. Twenty-five (39.1%) of the children received therapeutic hypothermia at 33 °C for 72 h. The 1-month survival rate was significantly higher (p = 0.037) in the therapeutic hypothermia group (15/25, 60%) than in the normothermia group (12/39, 30.8%). The therapeutic hypothermia group had significantly better neurological outcomes (7/15, 46.7%) than the normothermia group (1/12, 8.3%) (p = 0.043).
Paediatric asphyxial out-of-hospital cardiac arrest was associated with high mortality and morbidity. Seventy-two-hour therapeutic hypothermia was associated with a better 1-month survival rate and 6-month neurological outcomes than normothermia in our paediatric patients with asphyxial out-of-hospital cardiac arrest.
最近的研究表明，48 小时的治疗性低温方案并不能改善儿科院外心脏骤停幸存者的预后。本研究旨在评估与 35.5°C-37.5°C 的常温相比，33°C 的 72 小时治疗性低温对儿科窒息性院外心脏骤停幸存者的结局和不良事件发生率的影响。
我们在 2010 年 1 月至 2017 年 6 月期间在一家三级儿科重症监护病房进行了这项回顾性队列研究。所有年龄在 1 个月至 18 岁之间、有窒息性院外心脏骤停病史且至少有 3 分钟的胸外按压、循环恢复后存活 12 小时以上的儿童均符合研究入选标准。
64 名患儿符合研究纳入标准。64 名患儿中，49 名（76.6%）为男性，平均年龄为 4.86±5.26 岁。24 名（37.5%）患儿存在潜在疾病。总的 1 个月生存率为 43.2%。25 名（39.1%）患儿接受了 33°C 72 小时的治疗性低温。治疗性低温组（15/25，60%）1 个月生存率明显高于常温组（12/39，30.8%）（p=0.037）。治疗性低温组（7/15，46.7%）的神经功能结局明显优于常温组（1/12，8.3%）（p=0.043）。
儿科窒息性院外心脏骤停与高死亡率和高发病率相关。在我们的儿科窒息性院外心脏骤停患者中，72 小时的治疗性低温与更好的 1 个月生存率和 6 个月神经功能结局相关，优于常温。
