Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Resuscitation. 2021 May;162:365-371. doi: 10.1016/j.resuscitation.2021.01.029. Epub 2021 Feb 2.
Therapeutic cooling initiated during cardiopulmonary resuscitation (intra arrest therapeutic hypothermia, IATH) provided diverging effect on neurological outcome of out-of-hospital cardiac arrest (OHCA) patients depending on the initial cardiac rhythm and the cooling methods used.
We performed a systematic search of PubMed, EMBASE and the CENTRAL databases using established Medical Subject Headings (MeSH) terms for IATH and OHCA. Only studies comparing IATH to standard in-hospital targeted temperature management (TTM) were selected. We used the revised Cochrane RoB-2 and the Newcastle-Ottawa scale tool to assess risk of bias of each study. Primary outcome was favorable neurological outcome (FO); secondary outcomes included return of spontaneous circulation (ROSC) rate and survival to hospital discharge.
Out of 20,950 studies, 8 studies (n = 3493 patients, including 4 randomized trials, RCTs) were included in the final analysis. Compared to controls, the use of IATH was not associated with improved FO (OR 0.96 [95% CIs 0.68-1.37]; p = 0.84), increased ROSC rate (OR 1.11 [95% CIs 0.83-1.49]; p = 0.46) or survival (OR 0.91 [95% CIs 0.73-1.14]; p = 0.43). Significant heterogeneity among studies was observed for the analysis of ROSC rate (I = 69%). Trans-nasal evaporative cooling and cold fluids were explored in two RCTs each and no differences were observed on FO, event when only patients with an initial shockable rhythm were analyzed (OR 1.62 [95% CI 1.00-2.64]; p = 0.05].
In this meta-analysis, IATH was not associated with improved neurological outcome when compared to standard in-hospital TTM, based on very low certainty of evidence.
PROSPERO (CRD42019130322).
心肺复苏期间开始的治疗性冷却（停搏期治疗性低温，IATH）对院外心脏骤停（OHCA）患者的神经结局有不同的影响，这取决于初始心搏节律和使用的冷却方法。
我们使用已建立的医学主题词（MeSH）术语对 PubMed、EMBASE 和 CENTRAL 数据库进行了系统搜索，以搜索 IATH 和 OHCA。仅选择了比较 IATH 与标准院内目标温度管理（TTM）的研究。我们使用修订后的 Cochrane RoB-2 和纽卡斯尔-渥太华量表工具来评估每项研究的偏倚风险。主要结局是良好的神经结局（FO）；次要结局包括自主循环恢复（ROSC）率和存活至出院。
在 20950 项研究中，有 8 项研究（n=3493 例患者，包括 4 项随机试验，RCT）纳入最终分析。与对照组相比，使用 IATH 并未改善 FO（OR 0.96 [95% CI 0.68-1.37]；p=0.84）、增加 ROSC 率（OR 1.11 [95% CI 0.83-1.49]；p=0.46）或存活率（OR 0.91 [95% CI 0.73-1.14]；p=0.43）。在 ROSC 率的分析中观察到研究之间存在显著的异质性（I=69%）。经鼻蒸发冷却和冷液在两项 RCT 中各进行了探索，但在 FO 方面没有差异，甚至当仅分析初始可电击节律的患者时也是如此（OR 1.62 [95% CI 1.00-2.64]；p=0.05）。
在这项荟萃分析中，与标准院内 TTM 相比，IATH 并未改善神经结局，证据确定性非常低。
PROSPERO（CRD42019130322）。
