Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Sep;83(9):858-864. doi: 10.1097/JCMA.0000000000000343.
Evidences that support the use of targeted temperature management (TTM) for in-hospital cardiac arrest (IHCA) are lacking. We aimed to investigate the hypothesis that TTM benefits for patients with IHCA are similar to those with out-of-hospital cardiac arrest (OHCA) and to determine the independent predictors of resuscitation outcomes in patients with cardiac arrest receiving subsequent TTM.
This is a retrospective, matched, case-control study (ratio 1:1) including 93 patients with IHCA treated with TTM after the return of spontaneous circulation, who were admitted to Partners HealthCare system in Boston from January 2011 to December 2018. Controls were defined as the same number of patients with OHCA, matched for age, Charlson score, and sex. Survival and neurological outcomes upon discharge were the primary outcome measures.
Patients with IHCA were more likely to have experienced a witnessed arrest and receive bystander cardiopulmonary resuscitation, a larger total dosage of epinephrine, and extracorporeal membrane oxygenation. The time duration for ROSC was shorter in patients with IHCA than in those with OHCA. The IHCA group was more likely associated with mild thrombocytopenia during TTM than the OHCA group. Survival after discharge and favorable neurological outcomes did not differ between the two groups. Among all patients who had cardiac arrest treated with TTM, the initial shockable rhythm, time to ROSC, and medical history of heart failure were independent outcome predictors for survival to hospital discharge. The only factor to predict favorable neurological outcomes at discharge was initial shockable rhythm.
The beneficial effects of TTM in eligible patients with IHCA were similar with those with OHCA. Initial shockable rhythm was the only independent predictor of both survival and favorable neurological outcomes at discharge in all cardiac arrest survivors receiving TTM.
目前缺乏支持对院内心搏骤停（IHCA）使用目标温度管理（TTM）的证据。我们旨在研究 TTM 对 IHCA 患者的益处与对院外心搏骤停（OHCA）患者相似的假设，并确定接受后续 TTM 的心脏骤停患者复苏结果的独立预测因素。
这是一项回顾性、匹配、病例对照研究（比例为 1:1），纳入了 2011 年 1 月至 2018 年 12 月期间在波士顿 Partners HealthCare 系统接受 TTM 治疗后自主循环恢复的 93 例 IHCA 患者。对照组定义为相同数量的 OHCA 患者，按年龄、Charlson 评分和性别匹配。主要终点为出院时的存活和神经功能结局。
与 OHCA 患者相比，IHCA 患者更有可能经历目击性骤停并接受旁观者心肺复苏、更大剂量的肾上腺素和体外膜氧合。IHCA 患者的 ROSC 时间短于 OHCA 患者。与 OHCA 患者相比，在 TTM 期间，IHCA 患者更有可能出现轻度血小板减少症。两组出院后的存活率和良好的神经功能结局无差异。在所有接受 TTM 治疗的心脏骤停患者中，初始可除颤节律、ROSC 时间和心力衰竭病史是存活至出院的独立预后预测因素。唯一能预测出院时良好神经功能结局的因素是初始可除颤节律。
在符合条件的 IHCA 患者中，TTM 的有益效果与 OHCA 患者相似。初始可除颤节律是所有接受 TTM 的心脏骤停幸存者出院时存活和良好神经功能结局的唯一独立预测因素。
