Institute of Intensive Care Medicine, University Hospital of Zurich, Switzerland.
Department of Neurology, University Hospital of Zurich, Switzerland.
J Crit Care. 2021 Jun;63:146-153. doi: 10.1016/j.jcrc.2020.09.019. Epub 2020 Sep 22.
This study aims to compare protocol adherence, neurological outcome and adverse effects associated with a controlled hypothermia versus a controlled normothermia protocol in patients successfully resuscitated after cardiac arrest.
In this retrospective single-center study in a university intensive care unit in Switzerland, post-cardiac arrest patients were compared before and after a protocol change from targeted temperature management at 33 °C (TTM-33) to 36 °C (TTM-36) using an intravascular cooling device. Protocol adherence was assessed as the primary outcome. Secondary outcomes were in-hospital mortality, neurological outcome and adverse effects.
373 patients after cardiac arrest were screened, of whom a total of 133 patients were included. Protocol adherence was lower in the TTM-33 group (47% vs 87% of patients, p < 0.01). In-hospital mortality (59% vs 45%, p = 0.15) and neurological outcome (modified Rankin Score < 4 in 33% vs 39% and CPC-Score < 3 in 33% vs 39% of patients, p = 0.60 and 0.97) were similar. Overall incidence of adverse effects was comparable, with bradycardic arrhythmias occurring more frequently in the TTM-33 group.
Protocol adherence was higher in the TTM-36 group. In-hospital mortality and neurological outcome were similar, while bradycardic arrhythmias were encountered more often in TTM-33.
本研究旨在比较心脏骤停后成功复苏患者接受控制性低温与控制性常温方案时的方案依从性、神经结局和不良反应。
在瑞士一所大学重症监护室进行的这项回顾性单中心研究中，使用血管内冷却装置，将目标温度管理 33°C（TTM-33）改为 36°C（TTM-36）的方案改变前后，对心脏骤停后患者进行比较。方案依从性作为主要结局进行评估。次要结局为院内死亡率、神经结局和不良反应。
共筛选出 373 例心脏骤停患者，其中共有 133 例患者纳入研究。TTM-33 组的方案依从性较低（47%比 87%的患者，p<0.01）。院内死亡率（59%比 45%，p=0.15）和神经结局（改良Rankin 评分<4 的患者比例为 33%比 39%和 CPC 评分<3 的患者比例为 33%比 39%，p=0.60 和 0.97）相似。不良反应的总体发生率相当，TTM-33 组更常出现心动过缓性心律失常。
TTM-36 组的方案依从性更高。院内死亡率和神经结局相似，但 TTM-33 组更常发生心动过缓性心律失常。
