Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA.
Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA.
Crit Care Med. 2020 Mar;48(3):370-377. doi: 10.1097/CCM.0000000000004160.
Tailoring hypothermia duration to ischemia duration may improve outcome from out-of-hospital cardiac arrest. We investigated the association between the hypothermia/ischemia ratio and functional outcome in a secondary analysis of data from the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study trial.
Cohort study of out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study.
Multicenter study across North America.
Adult, nontraumatic, out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study who survived to hospital admission and received targeted temperature management between May 2012 and October 2015.
Targeted temperature management in comatose survivors of out-of-hospital cardiac arrest. We defined hypothermia/ischemia ratio as total targeted temperature management time (initiation through rewarming) divided by calculated total ischemia time (approximate time of arrest [9-1-1 call or emergency medical services-witnessed] to return of spontaneous circulation).
The primary outcome was hospital survival with good functional status (modified Rankin Score, 0-3) at hospital discharge. We fitted logistic regression models to estimate the association between hypothermia/ischemia ratio and the primary outcome, adjusting for demographics, arrest characteristics, and Resuscitation Outcomes Consortium enrolling site. A total of 3,429 patients were eligible for inclusion, of whom 36.2% were discharged with good functional outcome. Patients had a mean age of 62.0 years (SD, 15.8), with 69.7% male, and 58.0% receiving lay-rescuer cardiopulmonary resuscitation. Median time to return of spontaneous circulation was 21.1 minutes (interquartile range, 16.1-26.9), and median duration of targeted temperature management was 32.9 hours (interquartile range, 23.7-37.8). A total of 2,579 had complete data and were included in adjusted regression analyses. After adjustment for patient characteristics and Resuscitation Outcomes Consortium site, a greater hypothermia/ischemia ratio was associated with increased survival with good functional outcome (odds ratio, 2.01; 95% CI, 1.82-2.23). This relationship, however, appears to be primarily driven by time to return of spontaneous circulation in this patient cohort.
Although a larger hypothermia/ischemia ratio was associated with good functional outcome after out-of-hospital cardiac arrest in this cohort, this association is primarily driven by duration of time to return of spontaneous circulation. Tailoring duration of targeted temperature management based on duration of time to return of spontaneous circulation or patient characteristics requires prospective study.
根据停搏时间来调整低温持续时间可能会改善院外心脏骤停患者的预后。我们通过复苏结果联盟胺碘酮、利多卡因或安慰剂研究试验的数据的二次分析来研究低温/停搏比值与功能结局之间的关系。
对院外心脏骤停患者进行复苏结果联盟胺碘酮、利多卡因或安慰剂研究的队列研究。
北美的多中心研究。
接受过院外心脏骤停后目标温度管理的成年、非创伤性、院外心脏骤停患者，并在 2012 年 5 月至 2015 年 10 月期间接受了目标温度管理，直至入院。
昏迷的院外心脏骤停幸存者的目标温度管理。我们将低温/停搏比值定义为总目标温度管理时间（从开始到复温）除以计算出的总停搏时间（大约是骤停时间[9-1-1 呼叫或急救人员见证]到自主循环恢复）。
主要结局是院外心脏骤停患者出院时具有良好的功能状态（改良 Rankin 评分，0-3）的生存率。我们拟合了逻辑回归模型来估计低温/停搏比值与主要结局之间的关系，调整了人口统计学、骤停特征和复苏结果联盟的纳入站点。共有 3429 名患者符合纳入标准，其中 36.2%出院时功能良好。患者的平均年龄为 62.0 岁（标准差，15.8），69.7%为男性，58.0%接受非专业人员心肺复苏。自主循环恢复的中位时间为 21.1 分钟（四分位间距，16.1-26.9），目标温度管理的中位时间为 32.9 小时（四分位间距，23.7-37.8）。共有 2579 人有完整的数据，并纳入了调整后的回归分析。在调整了患者特征和复苏结果联盟的站点后，更大的低温/停搏比值与院外心脏骤停后良好的功能结局生存率增加相关（比值比，2.01；95%置信区间，1.82-2.23）。然而，在这个患者队列中，这种关系主要是由自主循环恢复时间决定的。
尽管在该队列中，院外心脏骤停后更大的低温/停搏比值与良好的功能结局相关，但这种关联主要是由自主循环恢复时间决定的。根据自主循环恢复时间或患者特征来调整目标温度管理的持续时间需要前瞻性研究。
