University of Connecticut School of Medicine, Farmington, CT, USA.
Division of Cardiology, Hartford Hospital, Hartford, CT, USA.
J Intensive Care Med. 2021 Dec;36(12):1392-1397. doi: 10.1177/0885066620982502. Epub 2020 Dec 30.
There is a paucity of data evaluating the impact of heart rate (HR) during Targeted Temperature Management (TTM) and neurologic outcomes. Current resuscitation guidelines do not specify a HR goal during TTM. We sought to determine the relationship between HR and neurologic outcomes in a single-center registry dataset.
We retrospectively studied 432 consecutive patients who completed TTM (33°C) after cardiac arrest from 2008 to 2017. We evaluated the relationship between neurologic outcomes and HR during TTM. Pittsburgh Cerebral Performance Categories (CPC) at discharge were used to determine neurological recovery. Statistical analysis included chi square, Student's t-test and Mann-Whitney U. A logistic regression model was created to evaluate the strength of contribution of selected variables on the outcome of interest.
Approximately 94,000 HR data points from 432 patients were retrospectively analyzed; the mean HR was 82.17 bpm over the duration of TTM. Favorable neurological outcomes were seen in 160 (37%) patients. The mean HR in the patients with a favorable outcome was lower than the mean HR of those with an unfavorable outcome (79.98 bpm vs 85.67 bpm p < 0.001). Patients with an average HR of 60-91 bpm were 2.4 times more likely to have a favorable neurological outcome compared to than HR's < 60 or > 91 (odds ratio [OR] = 2.36, 95% confidence interval [CI] 1.61-3.46, p < 0.001). Specifically, mean HR's in the 73-82 bpm range had the greatest rate of favorable outcomes (OR 3.56, 95% CI 1.95-6.50), p < 0.001. Administration of epinephrine, a history of diabetes mellitus and hypertension all were associated with worse neurological outcomes independent of HR.
During TTM, mean HRs between 60-91 showed a positive association with favorable outcomes. It is unclear whether a specific HR should be targeted during TTM or if heart rates between 60-91 bpm might be a sign of less neurological damage.
评估心率（HR）在目标温度管理（TTM）期间对神经结局的影响的数据很少。目前的复苏指南没有规定 TTM 期间的 HR 目标。我们试图在一个单中心登记数据集确定 HR 与神经结局之间的关系。
我们回顾性研究了 2008 年至 2017 年期间心脏骤停后完成 TTM（33°C）的 432 例连续患者。我们评估了 TTM 期间 HR 与神经结局之间的关系。出院时的匹兹堡大脑表现类别（CPC）用于确定神经恢复情况。统计分析包括卡方检验、学生 t 检验和曼-惠特尼 U 检验。创建了一个逻辑回归模型来评估所选变量对感兴趣结果的贡献强度。
从 432 名患者中回顾性分析了大约 94000 个 HR 数据点；在 TTM 期间的平均 HR 为 82.17 bpm。160 名（37%）患者的神经结局良好。在有良好结局的患者中，平均 HR 低于无不良结局的患者（79.98 bpm 与 85.67 bpm，p <0.001）。平均 HR 在 60-91 bpm 之间的患者发生良好神经结局的可能性是 HR < 60 或 > 91 的患者的 2.4 倍（比值比[OR] = 2.36，95%置信区间[CI] 1.61-3.46，p < 0.001）。具体来说，73-82 bpm 范围内的平均 HR 具有最高的良好结局率（OR 3.56，95%CI 1.95-6.50），p < 0.001。肾上腺素的使用、糖尿病和高血压史均与 HR 无关的不良神经结局相关。
在 TTM 期间，60-91 之间的平均 HRs 与良好的结果呈正相关。尚不清楚 TTM 期间是否应针对特定的 HR，或者 60-91 bpm 之间的心率是否可能是神经损伤程度较轻的迹象。
