Cragun Benjamin N, Hite Philp Frances, O'Neill John, Noorbakhsh Matthew R, Tindall Rachel P, Philp Allan S, Ditillo Michael F
1 Department of Trauma Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
2 Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Ther Hypothermia Temp Manag. 2019 Jun;9(2):156-158. doi: 10.1089/ther.2018.0022. Epub 2018 Nov 22.
Therapeutic hypothermia (TH) and targeted temperature management (TTM) have been shown to improve outcomes in survivors of cardiac arrest, but prior research has excluded trauma and postoperative patients. We sought to determine whether TH/TTM is safe in trauma and surgical patients. A retrospective cohort study was conducted at a single level I trauma center reviewing adults presenting as a traumatic arrest or cardiac arrest in the postoperative period with a Glasgow Coma Scale <8 after return of circulation who were treated with either TH or TTM. Neurological recovery is considered favorable if a patient was discharged following commands. A total of 32 cardiac arrest patients were included in the study, 14 of whom were treated with TH and 18 with TTM protocols, with goal temperatures of 33°C and 36°C, respectively. Mean age of the cohort was 60 ± 13, with 26 (81%) men. There were 18 trauma patients and 14 postoperative patients. Complications included pneumonia (13%), sepsis (6%), bleeding requiring transfusion (22%), arrhythmias (6%), and seizures (9%), which are similar to prior published series. Overall survival to discharge was 41% ( = 13), and all survivors had favorable neurological recovery. Traumatic arrest and perioperative cardiac arrest patients previously excluded from TH/TTM studies appear to have an acceptable incidence of complications compared with standard TH/TTM patients.
治疗性低温（TH）和目标温度管理（TTM）已被证明可改善心脏骤停幸存者的预后，但先前的研究排除了创伤患者和术后患者。我们试图确定TH/TTM在创伤和手术患者中是否安全。在一家一级创伤中心进行了一项回顾性队列研究，纳入了在循环恢复后格拉斯哥昏迷量表评分<8的创伤性心脏骤停或术后心脏骤停的成年患者，这些患者接受了TH或TTM治疗。如果患者能听从指令出院，则认为神经功能恢复良好。共有32例心脏骤停患者纳入研究，其中14例接受TH治疗，18例接受TTM方案治疗，目标温度分别为33°C和36°C。队列的平均年龄为60±13岁，男性26例（81%）。有18例创伤患者和14例术后患者。并发症包括肺炎（13%）、脓毒症（6%）、需要输血的出血（22%）、心律失常（6%）和癫痫发作（9%），与先前发表的系列研究相似。出院时的总体生存率为41%（n = 13），所有幸存者的神经功能恢复良好。与标准TH/TTM患者相比，先前被排除在TH/TTM研究之外的创伤性心脏骤停和围手术期心脏骤停患者的并发症发生率似乎可以接受。
