Department of Intensive Care, Erasme University Hospital, University of Brussels, Brussels, Belgium.
Department of Anesthesia and Intensive Care B, AOUI University Hospital Integrated Trust, University of Verona, Verona, Italy.
Minerva Anestesiol. 2020 Oct;86(10):1103-1110. doi: 10.23736/S0375-9393.20.14399-2. Epub 2020 May 28.
Among comatose survivors after cardiac arrest, target temperature management (TTM) is considered the most effective treatment to reduce the consequences of postanoxic brain injury. Several international guidelines have thus incorporated TTM in the management of the postresuscitation phase. However, despite extremely promising results in animal models and in randomized trials including selected patient cohorts, TTM benefits on neurological outcome have been questioned. Moreover, TTM potential side effects have raised some concerns on its wide application in all cardiac arrest patients in different healthcare systems. There is indeed still relatively large uncertainty concerning some practical aspects related to TTM application, such as: A) how to select patients who will benefit the most from TTM; B) the optimal time to initiate TTM; C) the best target temperature; D) the most effective methods to provide TTM; E) the length of the cooling phase; and F) the optimal rewarming rate and fever control strategies. The purpose of this manuscript is to review and discuss the most recent advances in TTM use after cardiac arrest and to give some proposals on how to deal with all these relevant practical questions.
在心脏骤停后的昏迷幸存者中，目标温度管理（TTM）被认为是最有效的治疗方法，可以减少缺氧性脑损伤的后果。因此，几项国际指南已将 TTM 纳入复苏后阶段的管理中。然而，尽管在动物模型和包括选定患者队列的随机试验中取得了非常有前景的结果，但 TTM 对神经功能结局的益处仍受到质疑。此外，TTM 的潜在副作用也引起了人们对其在不同医疗体系中广泛应用于所有心脏骤停患者的一些担忧。实际上，与 TTM 应用相关的一些实际方面仍存在较大的不确定性，例如：A）如何选择最能从 TTM 中受益的患者；B）启动 TTM 的最佳时间；C）最佳目标温度；D）提供 TTM 的最有效方法；E）冷却阶段的长度；以及 F）最佳复温率和发热控制策略。本文的目的是回顾和讨论心脏骤停后 TTM 使用的最新进展，并就如何处理所有这些相关的实际问题提出一些建议。
