Jun Gwang Soo, Kim Jae Guk, Choi Hyun Young, Kang Gu Hyun, Kim Wonhee, Jang Yong Soo, Kim Hyun Tae
Department of Emergency Medicine, College of Medicine, Hallym University, Kangnam Sacred Heart Hospital, Seoul.
Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.
Medicine (Baltimore). 2019 Jul;98(30):e16549. doi: 10.1097/MD.0000000000016549.
This study aimed to compare prognostic difference between intravascular cooling devices (ICDs) and surface cooling devices (SCDs) in targeted temperature management (TTM) recipients.Adult TTM recipients using ICD or SCD during 2012 to 2016 were included in this nationwide observational study. The outcome was survival to hospital discharge and good neurological outcome at hospital discharge.Among 142,905 out-of-hospital cardiac arrest patients, 1159 patients (SCD, n = 998; ICD, n = 161) were investigated. After propensity score matching for all patients, 161 matched pairs of patients were available for analysis (SCD, n = 161; ICD, n = 161). We observed no significant differences in the survival to hospital discharge (SCD, n = 144 [89.4%] vs ICD, n = 150 [93.2%], P = .32) and the good neurological outcomes (SCD, n = 86 [53.4%] vs ICD, n = 91 [56.5%], P = .65). TTM recipients were categorized by age groups (elderly [age >65 years] vs nonelderly [age ≤65 years]) to compare prognostic difference between ICD and SCD according to the age groups. In the nonelderly group, the use of ICD or SCD was not a significant factor for survival to hospital discharge or good neurologic outcome. Whereas, the use of ICD was significantly associated with good neurological outcome (odds ratio, 3.97; 95% confidence interval, 1.19 - 13.23, P = .02) compared with SCD in the elderly group.There were no significant differences in the survival to hospital discharge and the good neurological outcomes between SCD and ICD recipients. However, the use of ICD might be more beneficial than SCD in elderly patients.
本研究旨在比较血管内冷却装置（ICD）和体表冷却装置（SCD）在目标温度管理（TTM）接受者中的预后差异。本全国性观察性研究纳入了2012年至2016年期间使用ICD或SCD的成年TTM接受者。结局指标为出院存活及出院时良好的神经功能预后。在142,905例院外心脏骤停患者中，对1159例患者（SCD组998例；ICD组161例）进行了调查。对所有患者进行倾向得分匹配后，有161对匹配患者可供分析（SCD组161例；ICD组161例）。我们观察到出院存活情况（SCD组144例[89.4%] vs ICD组150例[93.2%]，P = 0.32）及良好神经功能预后情况（SCD组86例[53.4%] vs ICD组91例[56.5%]，P = 0.65）均无显著差异。根据年龄组（老年[年龄>65岁] vs 非老年[年龄≤65岁]）对TTM接受者进行分类，以比较ICD和SCD在不同年龄组中的预后差异。在非老年组中，使用ICD或SCD并非出院存活或良好神经功能预后的显著因素。然而，在老年组中，与SCD相比，使用ICD与良好神经功能预后显著相关（比值比，3.97；95%置信区间，1.19 - 13.23，P = 0.02）。SCD和ICD接受者在出院存活及良好神经功能预后方面无显著差异。然而，在老年患者中，使用ICD可能比SCD更有益。
