Department of Critical Care, Guy's and St. Thomas', King's College London, London, United Kingdom.
Chelsea and Westminster NHS Foundation Trust, London, United Kingdom.
Ther Hypothermia Temp Manag. 2021 Dec;11(4):230-237. doi: 10.1089/ther.2020.0028. Epub 2020 Dec 17.
Targeted temperature management (TTM) is recommended after out-of-hospital cardiac arrest (OHCA). However, interpretation of the evidence and translation into clinical practice, to realize benefits to patient outcomes may be inconsistent. This study aims to compare compliance with the recommended targeted temperatures and the use of intravascular temperature management (IVTM), as well as 90-day survival, before and after publication of the TTM trial. A single-center retrospective cohort study was conducted from 2010 to 2017. All comatose patients admitted to the intensive care unit after OHCA, who survived for ≥24 hours, were included. IVTM use was measured and TTM adherence was defined as the percentage time the core temperature was (1) within the guideline-recommended temperature range (initially 32-34°C, later modified to 32-36°C) for the first 24 hours, and (2) ≤37.5°C between 24 and 72 hours following admission. Multiple logistic regression analyses were performed for the use of IVTM and survival at 90 days. Of the 302 patients identified, 136 (45%) were pre-TTM, and 166 (55%) post-TTM. Baseline characteristics were similar between the groups. IVTM use decreased significantly (77.9% vs. 51.8%, < 0.001) after the publication of the TTM trial. Adherence to the 32-34°C and 32-36°C targets was higher pre-TTM as compared with the post-TTM cohort (33.3% [0-66.7%] vs. 0% [0-16.7%], < 0.001 and 83.3% [50.0-100%] vs. 36.7% [16.7-66.7%], < 0.001, respectively). Time with temperature ≥37.5°C in the first 24 hours was higher post-TTM ( = < 0.001) but not between 24 and 72 hours. Ninety-day survival was 54.4% in the pre-TTM cohort and 44.0% post-TTM, (odds ratio 1.52 [0.96-2.40], = 0.083). Adherence with recommended TTM decreased significantly following publication of the TTM trial and this was explained by a significant decrease in IVTM use. However, this concerning trend did not result in a statistically significant difference in survival.
目标温度管理（TTM）推荐用于院外心脏骤停（OHCA）后。然而，对证据的解释和转化为临床实践，以实现对患者预后的益处可能不一致。本研究旨在比较 TTM 试验发表前后，建议的目标温度和血管内温度管理（IVTM）的依从性以及 90 天生存率。这是一项从 2010 年到 2017 年进行的单中心回顾性队列研究。纳入了 OHCA 后存活≥24 小时并入住重症监护病房的所有昏迷患者。测量了 IVTM 的使用情况，并将 TTM 依从性定义为核心体温在（1）24 小时内处于指南推荐温度范围（最初为 32-34°C，后来修改为 32-36°C）的时间百分比，以及（2）在入院后 24 至 72 小时内≤37.5°C 的时间百分比。对 IVTM 的使用和 90 天的生存率进行了多变量逻辑回归分析。在确定的 302 名患者中，136 名（45%）为 TTM 前，166 名（55%）为 TTM 后。两组的基线特征相似。在 TTM 试验发表后，IVTM 的使用明显减少（77.9% vs. 51.8%，<0.001）。与 TTM 后队列相比，TTM 前队列对 32-34°C 和 32-36°C 目标的依从性更高（33.3% [0-66.7%] vs. 0% [0-16.7%]，<0.001 和 83.3% [50.0-100%] vs. 36.7% [16.7-66.7%]，<0.001）。TTM 后 24 小时内体温≥37.5°C 的时间更高（= < 0.001），但 24 至 72 小时之间则没有。TTM 前队列的 90 天生存率为 54.4%，TTM 后为 44.0%，（比值比 1.52 [0.96-2.40]，= 0.083）。TTM 试验发表后，TTM 的依从性显著下降，这解释了 IVTM 使用的显著下降。然而，这一令人担忧的趋势并没有导致生存率的统计学显著差异。
