Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; NewYork-Presbyterian Brooklyn Methodist Hospital, New York.
Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Heart Rhythm. 2021 Jul;18(7):1162-1170. doi: 10.1016/j.hrthm.2021.03.011. Epub 2021 Mar 6.
Targeted temperature management (TTM) improves neurologic outcome after cardiac arrest. However, better neurologic prognostication is needed.
The purpose of this study was to test the hypothesis that noninvasive recording of skin sympathetic nerve activity (SKNA) and its association with heart rate (HR) during TTM may serve as a biomarker of neurologic status.
SKNA recordings were analyzed from 29 patients undergoing TTM. Patients were grouped based on Clinical Performance Category (CPC) score into group 1 (CPC 1-2) representing a good neurologic outcome and group 2 (CPC 3-5) representing a poor neurologic outcome.
Of the 29 study participants, 18 (62%) were deemed to have poor neurologic outcome. At all timepoints, low average skin sympathetic nerve activity (aSKNA) was associated with poor neurologic outcome (odds ratio 22.69; P = .002) and remained significant (P = .03) even when adjusting for presenting clinical factors. The changes in aSKNA and HR during warming in group 1 were significantly correlated (ρ = 0.49; P <.001), even when adjusting for corresponding temperature and mean arterial pressure measurements (P = .017), whereas this correlation was not observed in group 2. Corresponding to high aSKNA, there was increased nerve burst activity during warming in group 1 compared to group 2 (0.739 ± 0.451 vs 0.176 ± 0.231; P = .013).
Neurologic recovery was retrospectively associated with SKNA. Patients undergoing TTM who did not achieve neurologic recovery were associated with low SKNA and lacked a significant correlation between SKNA and HR. These preliminary results indicate that SKNA may potentially be a useful biomarker to predict neurologic status in patients undergoing TTM.
目标温度管理（TTM）可改善心搏骤停后的神经功能预后。然而，需要更好的神经预后预测方法。
本研究旨在验证假设，即 TTM 期间非侵入性记录皮肤交感神经活动（SKNA）及其与心率（HR）的关联可作为神经状态的生物标志物。
对 29 例行 TTM 的患者进行 SKNA 记录分析。根据临床表现分类（CPC）评分将患者分为两组：CPC 1-2 组（代表良好的神经功能预后）和 CPC 3-5 组（代表不良的神经功能预后）。
29 名研究参与者中，18 名（62%）被认为神经功能预后不良。在所有时间点，低平均皮肤交感神经活动（aSKNA）与不良神经功能预后相关（优势比 22.69；P =.002），即使在调整了初始临床因素后仍然显著（P =.03）。在 CPC 1 组中，aSKNA 和 HR 在升温期间的变化呈显著相关性（ρ = 0.49；P <.001），即使在调整相应的温度和平均动脉压测量值后也是如此（P =.017），而在 CPC 2 组中则未观察到这种相关性。与高 aSKNA 相对应，在 CPC 1 组中，与 CPC 2 组相比，升温期间神经爆发活动增加（0.739 ± 0.451 对 0.176 ± 0.231；P =.013）。
神经恢复与 SKNA 呈回顾性相关。在 TTM 过程中未实现神经恢复的患者与低 SKNA 相关，且 SKNA 与 HR 之间缺乏显著相关性。这些初步结果表明，SKNA 可能是预测 TTM 患者神经状态的有用生物标志物。
