Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Ther Hypothermia Temp Manag. 2020 Sep;10(3):153-158. doi: 10.1089/ther.2019.0019. Epub 2019 Jul 17.
Targeted temperature management (TTM) is widely used for postcardiac arrest management of patients with out-of-hospital cardiac arrest. However, the use of TTM for patients with in-hospital cardiac arrest (IHCA) is controversial. The aim of this study was to investigate the role of TTM in the management of patients with IHCA. The medical records of all IHCA patients who were resuscitated and returned to spontaneous circulation from January 2011 to December 2016 were reviewed. After excluding patients with new do not resuscitate orders and those who died within 24 hours, 262 patients were eligible for analysis. Thirty-five of the 262 patients (13.3%) received TTM after IHCA. Patients who received TTM and standard supportive care (SSC) had similar baseline epidemiological status. The TTM patients were older and had a longer cardiac pulmonary resuscitation duration; however, the differences were not statistically significant. The 28-day survival rate was not significantly different between groups (12/35 in the TTM group [34%] vs. 114/225 in the SSC group [50%], = 0.079). In the patients with good neurological status before arrest (Glasgow-Pittsburgh cerebral performance category [GP-CPC] scores: 1-2), there was no significant difference in the 28-day survival between groups (11/26 in the TTM group [42.3%] vs. 81/154 [52.6%] in the SSC group; = 0.332). In this subgroup, the TTM patients had poorer neurological outcomes at discharge (GP-CPC score 1-2) than the SSC patients (1/26 in the TTM group [3.8%] vs. 57/154 in the SSC group [37%]; = 0.001). TTM was not associated with better 28-day survival than usual care among the patients with IHCA in this study, and the TTM patients had less favorable neurological outcomes at discharge. Randomized clinical trials are needed to assess the efficacy of TTM for IHCA patients.
目标温度管理（TTM）广泛用于院外心脏骤停后心脏骤停患者的管理。然而，TTM 用于院内心脏骤停（IHCA）患者的使用存在争议。本研究旨在探讨 TTM 在 IHCA 患者管理中的作用。回顾了 2011 年 1 月至 2016 年 12 月期间所有复苏并恢复自主循环的 IHCA 患者的病历。排除新的不复苏医嘱和 24 小时内死亡的患者后，共有 262 例患者符合分析条件。在 262 例患者中，有 262 例（13.3%）在 IHCA 后接受了 TTM。接受 TTM 和标准支持性治疗（SSC）的患者具有相似的基线流行病学状况。TTM 患者年龄较大，心肺复苏持续时间较长，但差异无统计学意义。两组 28 天生存率无显著差异（TTM 组 12/35 [34%]与 SSC 组 114/225 [50%]，=0.079）。在心脏骤停前神经状态良好的患者（格拉斯哥-匹兹堡脑功能表现分类 [GP-CPC]评分：1-2）中，两组 28 天生存率无显著差异（TTM 组 11/26 [42.3%]与 SSC 组 81/154 [52.6%]，=0.332）。在该亚组中，TTM 患者出院时神经结局较差（GP-CPC 评分 1-2），与 SSC 患者相比（TTM 组 1/26 [3.8%]与 SSC 组 57/154 [37%]，=0.001）。与常规治疗相比，TTM 并未使 IHCA 患者的 28 天生存率更好，TTM 患者出院时的神经结局更差。需要进行随机临床试验来评估 TTM 对 IHCA 患者的疗效。
