Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan; Emergency Medical Center, Kagawa University Hospital, Japan.
Emergency Medical Center, Kagawa University Hospital, Japan; Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan.
Resuscitation. 2020 Jan 1;146:170-177. doi: 10.1016/j.resuscitation.2019.07.029. Epub 2019 Aug 5.
The European Resuscitation Council guidelines recommend a slow rate of rewarming of 0.25 °C/h-0.5 °C/h for out-of-hospital cardiac arrest (OHCA) patients receiving therapeutic hypothermia (TH). Conversely, a very slow rewarming of 1 °C/day is generally applied in Japan. The rewarming duration ranged from less than 24 h up to more than 50 h. No randomized control trials have examined the optimal rewarming speed for TH in OHCA patients. Therefore, we examined the association between the rewarming duration and neurological outcomes in OHCA patients who received TH.
This study was a secondary analysis of the Japanese Population-based Utstein-style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia (J-PULSE-HYPO) study registry, a multicenter prospective cohort study. Patients suffering from OHCA who received TH (target temperature, 34 °C) after the return of spontaneous circulation from 2005 to 2011 in 14 hospitals throughout Japan were enrolled. The rewarming duration was defined as the time from the beginning of rewarming at a target temperature of 34 °C until reaching 36 °C. The primary outcome was an unfavorable neurological outcome at hospital discharge, i.e., a cerebral performance category of 3-5.
The J-PULSE-HYPO study enrolled 452 OHCA patients. Of these, 328 were analyzed; 79.9% survived to hospital discharge, of which 56.4% had a favorable neurological outcome. Multivariable logistic regression analysis revealed that the rewarming duration was independently associated with unfavorable neurological outcomes [odds ratio (per 5 h), 0.89; 95% confidence interval, 0.79-0.99; p = 0.032].
A longer rewarming duration was significantly associated with and was an independent predictor of favorable neurological outcomes in OHCA patients who received TH.
欧洲复苏委员会指南建议对接受治疗性低温治疗（TH）的院外心脏骤停（OHCA）患者以 0.25°C/h-0.5°C/h 的缓慢速率复温。相反，日本通常采用非常缓慢的 1°C/天复温。复温时间从不到 24 小时到超过 50 小时不等。没有随机对照试验研究过 OHCA 患者 TH 的最佳复温速度。因此，我们研究了接受 TH 的 OHCA 患者复温时间与神经结局之间的关系。
这是日本人群基础除颤和基础/高级生命支持教育及实施-低温（J-PULSE-HYPO）研究登记处的二次分析，这是一项多中心前瞻性队列研究。该研究纳入了 2005 年至 2011 年期间日本 14 家医院的 OHCA 患者，这些患者在自主循环恢复后接受 TH（目标温度为 34°C）。复温时间定义为从开始以 34°C 的目标温度复温到达到 36°C 的时间。主要结局是出院时的不良神经结局，即脑功能分类 3-5。
J-PULSE-HYPO 研究纳入了 452 例 OHCA 患者。其中 328 例进行了分析；79.9%的患者存活至出院，其中 56.4%的患者神经结局良好。多变量逻辑回归分析显示，复温时间与不良神经结局独立相关[优势比（每 5 小时），0.89；95%置信区间，0.79-0.99；p=0.032]。
在接受 TH 的 OHCA 患者中，较长的复温时间与良好的神经结局显著相关，且是其独立预测因素。
