Department of Emergency Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Resuscitation. 2021 Oct;167:362-371. doi: 10.1016/j.resuscitation.2021.07.026. Epub 2021 Jul 29.
To investigate whether regional cerebral oxygen saturation (rSO) differs in out-of-hospital cardiac arrest (OHCA) survivors undergoing targeted temperature management (TTM) 36 °C versus 33 °C.
A randomized clinical trial was conducted at intensive care units in two referral hospitals. Fifty-seven comatose OHCA survivors were randomized into either a 36 °C or 33 °C group. Patients were cooled and maintained at an oesophageal temperature of either 36 °C or 33 °C for 24 hours, rewarmed at a rate of 0.25 °C/hour, and maintained at <37.5 °C until 72 hours. During 72 hours of TTM, rSO was continuously monitored on the left forehead using near-infrared spectroscopy (INVOS 5100C). The rSO level at 72 hours was compared between the two groups. Next, serial rSO levels for 72 hours were compared using mixed effects regression. The association between rSO levels and 6-month neurological outcomes was also evaluated.
There were no significant differences in the rSO level at 72 hours between the 36 °C and 33 °C groups (p = 0.372). Furthermore, serial rSO levels for 72 hours of TTM were not different between the two groups (p = 0.733). However, low rSO levels, particularly at 24 hours of TTM, were significantly associated with poor 6-month neurological outcomes (odds ratio = 0.899, 95% confidence interval: 0.831-0.974). The area under the receiver operating characteristic curve of the rSO level at 24 hours for poor neurological outcomes was 0.800.
Regardless of target temperatures, low rSO levels during TTM were significantly associated with poor 6-month neurological outcomes in OHCA survivors.
研究在接受目标温度管理（TTM）36°C 与 33°C 的院外心脏骤停（OHCA）幸存者中，区域性脑氧饱和度（rSO）是否存在差异。
在两家转诊医院的重症监护病房进行了一项随机临床试验。57 例昏迷的 OHCA 幸存者被随机分为 36°C 组或 33°C 组。患者被冷却并维持食管温度在 36°C 或 33°C 24 小时，以 0.25°C/h 的速度复温，并在 72 小时内维持体温<37.5°C。在 72 小时的 TTM 期间，使用近红外光谱（INVOS 5100C）连续监测左额部 rSO。比较两组患者在 72 小时时的 rSO 水平。然后，使用混合效应回归比较 72 小时的 rSO 水平。还评估了 rSO 水平与 6 个月神经功能结局之间的关系。
36°C 组与 33°C 组在 72 小时时的 rSO 水平无显著差异（p=0.372）。此外，两组患者在 72 小时的 TTM 期间 rSO 水平的变化无差异（p=0.733）。然而，低 rSO 水平，特别是在 TTM 24 小时时，与不良 6 个月神经功能结局显著相关（优势比=0.899，95%置信区间：0.831-0.974）。24 小时 rSO 水平预测不良神经功能结局的受试者工作特征曲线下面积为 0.800。
无论目标温度如何，TTM 期间的低 rSO 水平与 OHCA 幸存者 6 个月不良神经功能结局显著相关。
