Department of Clinical Research, Centre for Prehospital and Emergency Research, Aalborg University, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark.
Resuscitation. 2021 May;162:63-69. doi: 10.1016/j.resuscitation.2021.02.005. Epub 2021 Feb 12.
Evaluate the relationship between heat generation during rewarming in post-cardiac arrest patients receiving targeted temperature management (TTM) as a surrogate of thermoregulatory ability and clinical outcomes.
This is a prospective observational single-centre study conducted at an urban tertiary-care hospital. We included post-cardiac arrest adults who received TTM via surface cooling device between April 2018 and June 2019.
Patient heat generation was calculated by multiplying the inverse of the average machine water temperature with time to rewarm to 37 °C and standardized in two ways to account for target temperature variation: (1) divided by number of degrees between target temperature and 37 °C, and (2) limited to when patient was rewarmed from 36 °C to 37 °C. The primary outcome was poor neurologic status, defined as Cerebral Performance Category (CPC) score 3-5, and the secondary outcome was 30-day survival. Sixty-six patients were included: 45 (68%) had a CPC-score of 3-5 and 23 (35%) were alive at 30 days. Besides initial rhythm and arrest downtime, baseline characteristics were similar between outcomes. Heat generation was not associated with poor neurological outcome (CPC 3-5: 6.6 [IQR: 6.1, 7.4] versus CPC 1-2: 6.6 [IQR: 5.7, 7.6], p = 0.89) or survival at 30 days (non-survivors: 6.6 [IQR: 6.6, 7.4] vs. survivors: 6.6 [IQR: 5.7, 8.0, p = 0.78]).
Heat generation during rewarming was not associated with neurologic outcomes. However, there was a relationship between poor neurological outcome and higher median water temperatures. Time to rewarm was prolonged in patients with poor neurological outcome.
评估心脏骤停后接受目标温度管理（TTM）的患者复温过程中的产热量作为体温调节能力的替代指标与临床结局的关系。
这是一项在城市三级医院进行的前瞻性观察性单中心研究。我们纳入了 2018 年 4 月至 2019 年 6 月期间接受表面冷却设备 TTM 的成年心脏骤停患者。
患者产热量通过将平均机器水温的倒数乘以复温至 37°C 的时间来计算，并通过两种方式标准化，以考虑目标温度的变化：（1）除以目标温度与 37°C 之间的度数，（2）仅限于从 36°C 复温至 37°C 时。主要结局是神经功能不良，定义为神经功能缺损评分（Cerebral Performance Category，CPC）为 3-5 分，次要结局为 30 天存活率。共纳入 66 例患者：45 例（68%）CPC 评分为 3-5 分，23 例（35%）在 30 天存活。除初始节律和停搏时间外，结局之间的基线特征相似。产热量与不良神经结局（CPC 3-5：6.6 [IQR：6.1，7.4] vs. CPC 1-2：6.6 [IQR：5.7，7.6]，p=0.89）或 30 天存活率（非幸存者：6.6 [IQR：6.6，7.4] vs. 幸存者：6.6 [IQR：5.7，8.0]，p=0.78）均无相关性。
复温过程中的产热量与神经结局无关。然而，神经结局不良与较高的中位水温之间存在关系。神经结局不良患者的复温时间延长。
