Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Solna, Sweden; Department of Anaesthesiology and Intensive Care, Norrtälje Hospital, Sweden.
Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Solna, Sweden.
Resuscitation. 2019 Oct;143:142-147. doi: 10.1016/j.resuscitation.2019.08.029. Epub 2019 Aug 27.
There are limited data on long-term outcome in out-of-hospital cardiac arrest patients following the treatment shift of target temperature management (TTM) from 33 °C to 36 °C outside the controlled settings of randomised trials. The aim of this study was to evaluate the adherence to TTM guidelines after the publication of the TTM trial and if the change in temperature level influence six-month survival.
OHCA patients admitted to intensive care units (ICU) and recorded in the Swedish Intensive Care Registry (January 2010-March 2016) were included. Each ICU in Sweden provided information on their TTM target (i.e. 33 °C [TTM33] or 36 °C [TTM36]) used and the date of shift to 36 °C. The primary outcome was six-months survival. Multivariate logistic regression and propensity score match was used to adjust for confounders.
In total, 2899 OHCA patients from 69 ICUs were assessed; of those, 1038 patients were treated with TTM (TTM33, n = 755 and TTM36, n = 283). Patients receiving any TTM decreased during the study period from 70.5% to 54.5% (p for trend <0.001). There was no significant difference in six-month survival between the TTM33 (47.2%) and the TTM36 (47.3%) groups (adjusted OR 1.12 [0.80-1.56]. In the propensity score matched analysis the six-months survival was 52.7 vs 47.3 %, OR 1.29 [0.90-1.85]).
The proportion of patients receiving therapeutic hypothermia in Sweden has decreased significantly since the publication of the TTM-trial indicating lower adherence to guidelines. This was not associated with any significant difference in long term outcome.
在目标温度管理（TTM）的治疗温度从随机试验的受控环境中的 33°C 转移到 36°C 之外的院外心脏骤停患者的长期预后数据有限。本研究的目的是评估 TTM 试验发表后 TTM 指南的遵循情况，以及温度水平的变化是否会影响 6 个月的生存率。
纳入 2010 年 1 月至 2016 年 3 月期间在瑞典重症监护登记处（Swedish Intensive Care Registry）记录的入住重症监护病房（ICU）的院外心脏骤停患者。瑞典的每个 ICU 都提供了他们使用的 TTM 目标（即 33°C [TTM33]或 36°C [TTM36]）和转移到 36°C 的日期。主要结局是 6 个月的生存率。多变量逻辑回归和倾向评分匹配用于调整混杂因素。
共评估了 69 个 ICU 的 2899 例 OHCA 患者；其中 1038 例接受了 TTM 治疗（TTM33，n=755 例；TTM36，n=283 例）。在研究期间，接受任何 TTM 的患者比例从 70.5%下降到 54.5%（趋势性 p<0.001）。TTM33 组（47.2%）和 TTM36 组（47.3%）的 6 个月生存率无显著差异（调整后的 OR 1.12 [0.80-1.56]）。在倾向评分匹配分析中，6 个月生存率为 52.7% vs 47.3%，OR 1.29 [0.90-1.85]）。
自 TTM 试验发表以来，瑞典接受治疗性低温治疗的患者比例显著下降，表明对指南的遵循程度较低。这与长期预后无显著差异无关。
