Kim Jae Guk, Shin Hyungoo, Choi Hyun Young, Kim Wonhee, Kim Jihoon, Moon Shinje, Kim Bongyoung, Ahn Chiwon, Lee Juncheol
Department of Emergency Medicine, Hallym University College of Medicine.
Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon.
Medicine (Baltimore). 2020 Apr;99(15):e19581. doi: 10.1097/MD.0000000000019581.
Targeted temperature management (TTM) is recommended for comatose patients after out-of-hospital cardiac arrests (OHCAs). Even after successful TTM, several factors could influence the neuroprotective effect of TTM. The aim of this study is to identify prognostic factors associated with good neurological outcomes in TTM recipients.This study used nationwide data during 2012 to 2016 to investigate prognostic factors associated with good neurological outcomes in patients who received TTM after the return of spontaneous circulation (ROSC). Multivariate logistic regression analysis was conducted to analyse the factors that may affect the neurological outcomes in the TTM recipients.The study included 1578 eligible patients, comprising 767 with good and 811 with poor neurological outcomes. Multivariable analyses showed that OHCA in public places (OR, 1.599; 95% CI, 1.100-2.323, P = .014), initial shockable rhythms (OR, 1.721; 95% CI, 1.191-2.486, P = .004), pre-hospital ROSCs (OR, 6.748; 95% CI, 4.703-9.682, P < .001), bystander cardiopulmonary resuscitation (CPR) (OR, 1.715; 95% CI, 1.200-2.450, P = .003), and primary coronary interventions (PCIs) (OR, 2.488; 95% CI, 1.639-3.778, P < .001) were statistically significantly associated with good neurological outcomes. Whereas, increase of age (OR, 0.962; 95% CI, 0.950-0.974, P < .001) and conventional cooling (OR, 0.478; 95% CI, 0.255-0.895, P = .021) were statistically significantly associated with poor neurological outcome.This study suggests that being younger, experiencing OHCA in public places, having initial shockable rhythm, pre-hospital ROSC, and bystander CPR, implementing PCIs and applying intravascular or surface cooling devices compared to conventional cooling method could predict good neurological outcomes in post-cardiac arrest patients who received TTM.
对于院外心脏骤停（OHCA）后的昏迷患者，推荐进行目标温度管理（TTM）。即使在成功实施TTM后，仍有几个因素可能影响TTM的神经保护作用。本研究的目的是确定与接受TTM患者良好神经功能预后相关的预后因素。本研究使用2012年至2016年的全国数据，调查自主循环恢复（ROSC）后接受TTM患者中与良好神经功能预后相关的预后因素。进行多变量逻辑回归分析以分析可能影响接受TTM患者神经功能预后的因素。该研究纳入了1578例符合条件的患者，其中767例神经功能预后良好，811例神经功能预后不良。多变量分析显示，公共场所发生OHCA（比值比[OR]，1.599；95%置信区间[CI]，1.100 - 2.323，P = 0.014）、初始可电击心律（OR，1.721；95% CI，1.191 - 2.486，P = 0.004）、院前ROSC（OR，6.748；95% CI，4.703 - 9.682，P < 0.001）、旁观者心肺复苏（CPR）（OR，1.715；95% CI，1.200 - 2.450，P = 0.003）以及初级冠状动脉介入治疗（PCI）（OR，2.488；95% CI，1.639 - 3.778，P < 0.001）与良好的神经功能预后在统计学上显著相关。然而，年龄增加（OR，0.962；95% CI，0.950 - 0.974，P < 0.001）和传统降温（OR，0.478；95% CI，0.255 - 0.895，P = 0.021）与不良神经功能预后在统计学上显著相关。本研究表明，与传统降温方法相比，年龄较轻、在公共场所发生OHCA、有初始可电击心律、院前ROSC、旁观者CPR、实施PCI以及应用血管内或体表降温设备可能预示接受TTM的心脏骤停后患者有良好的神经功能预后。
