Thomas Jefferson University, Philadelphia, Pennsylvania.
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2020 Dec;110(6):1926-1932. doi: 10.1016/j.athoracsur.2020.04.076. Epub 2020 Jun 3.
Extracorporeal life support (ECLS) has been used in the treatment of accidental hypothermia with hemodynamic instability, with promising outcomes. This systematic review examines ECLS treatment of accidental hypothermia to assess outcomes.
An electronic search was performed to identify articles reporting ECLS use for treatment of accidental hypothermia. Only reports describing patients aged more than 16 years after January 1, 2005, were included. Nineteen studies were identified comprising 47 patients. Demographic information, perioperative variables, and outcomes were extracted for analysis.
Median patient age was 48 years (interquartile range (IQR), 29 to 56), and 72.3% (34 of 47) were male. On presentation, median body temperature was 24.6°C (IQR, 22.2° to 26°C), median potassium level 4.3 mmol/L (IQR, 3.4 to 4.6 mmol/L), and median Glasgow Coma Scale score 3 (IQR, 3 to 7). Cardiac arrest occurred in 35 of 47 patients (74.5%). Median time to ECLS initiation from scene was 155 minutes (IQR, 113 to 245). Median ECLS duration was 18 hours (IQR, 4 to 27), with median rewarming rate of 2°C per hour (IQR, 1.5° to 4°). Median intensive care unit stay and hospital length of stay were 8 days (IQR, 2 to 16) and 17 days (IQR, 10 to 36), respectively. Inhospital mortality was 19.1% (9 of 47). Median discharge Glasgow Coma Scale score was 15 (IQR, 15 to 15) with minor long-term cognitive impairments noted in 6 of 47 patients (19.4%). Survival was significantly associated with potassium on presentation (P < .001), initial body temperature (P < .001), and ECLS rewarming rate (P < .001).
Extracorporeal life support is a viable cardiac support option for rewarming patients with accidental hypothermia, and initial potassium level, initial body temperature, and ECLS rewarming rate appear to be significantly associated with survival.
体外生命支持（ECLS）已被用于治疗伴有血流动力学不稳定的意外低体温，其治疗效果较为乐观。本系统评价通过研究 ECLS 治疗意外低体温的效果来评估其预后。
电子检索 2005 年 1 月 1 日后，描述年龄超过 16 岁的患者接受 ECLS 治疗意外低体温的相关文献。共纳入 19 项研究，包含 47 名患者。提取分析患者的人口统计学信息、围手术期变量和结局。
患者中位年龄为 48 岁（四分位间距 29 至 56），72.3%（34/47）为男性。入院时，中位体温为 24.6°C（四分位间距 22.2°至 26°C），中位血钾水平为 4.3mmol/L（四分位间距 3.4 至 4.6mmol/L），格拉斯哥昏迷评分中位数为 3 分（四分位间距 3 至 7）。47 例患者中 35 例（74.5%）发生心搏骤停。从现场开始接受 ECLS 治疗的中位时间为 155 分钟（四分位间距 113 至 245）。ECLS 中位持续时间为 18 小时（四分位间距 4 至 27），中位复温率为 2°C/小时（四分位间距 1.5°至 4°）。中位 ICU 住院时间和住院时间分别为 8 天（四分位间距 2 至 16）和 17 天（四分位间距 10 至 36）。院内死亡率为 19.1%（9/47）。出院时格拉斯哥昏迷评分中位数为 15 分（四分位间距 15 至 15），47 例患者中有 6 例（19.4%）出现轻微的长期认知障碍。生存与入院时的血钾（P<0.001）、初始体温（P<0.001）和 ECLS 复温率（P<0.001）显著相关。
体外生命支持是治疗意外低体温患者的可行心脏支持选择，初始血钾水平、初始体温和 ECLS 复温率与生存率显著相关。
