Sanfilippo Filippo, La Via Luigi, Lanzafame Bruno, Dezio Veronica, Busalacchi Diana, Messina Antonio, Ristagno Giuseppe, Pelosi Paolo, Astuto Marinella
Department of Anaesthesia and Intensive Care, "Policlinico-Vittorio Emanuele" University Hospital, 95123 Catania, Italy.
School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123 Catania, Italy.
J Clin Med. 2021 Aug 31;10(17):3943. doi: 10.3390/jcm10173943.
Target temperature management (TTM) in cardiac arrest (CA) survivors is recommended after hospital admission for its possible beneficial effects on survival and neurological outcome. Whether a lower target temperature (i.e., 32-34 °C) improves outcomes is unclear. We conducted a systematic review and meta-analysis on Pubmed and EMBASE to evaluate the effects on mortality and neurologic outcome of TTM at 32-34 °C as compared to controls (patients cared with "actively controlled" or "uncontrolled" normothermia). Results were analyzed via risk ratios (RR) and 95% confidence intervals (CI). Eight randomized controlled trials (RCTs) were included. TTM at 32-34 °C was compared to "actively controlled" normothermia in three RCTs and to "uncontrolled" normothermia in five RCTs. TTM at 32-34 °C does not improve survival as compared to normothermia (RR:1.06 (95%CI 0.94, 1.20), = 0.36; I = 39%). In the subgroup analyses, TTM at 32-34 °C is associated with better survival when compared to "uncontrolled" normothermia (RR: 1.31 (95%CI 1.07, 1.59), = 0.008) but shows no beneficial effects when compared to "actively controlled" normothermia (RR: 0.97 (95%CI 0.90, 1.04), = 0.41). TTM at 32-34 °C does not improve neurological outcome as compared to normothermia (RR: 1.17 (95%CI 0.97, 1.41), = 0.10; I = 60%). TTM at 32-34 °C increases the risk of arrhythmias (RR: 1.35 (95%CI 1.16, 1.57), = 0.0001, I = 0%). TTM at 32-34 °C does not improve survival nor neurological outcome after CA and increases the risk of arrhythmias.
心脏骤停（CA）幸存者入院后建议进行目标温度管理（TTM），因为其可能对生存和神经功能结局产生有益影响。较低的目标温度（即32-34°C）是否能改善结局尚不清楚。我们在PubMed和EMBASE上进行了一项系统评价和荟萃分析，以评估与对照组（接受“积极控制”或“未控制”正常体温治疗的患者）相比，32-34°C的TTM对死亡率和神经功能结局的影响。通过风险比（RR）和95%置信区间（CI）分析结果。纳入了八项随机对照试验（RCT）。在三项RCT中，将32-34°C的TTM与“积极控制”的正常体温进行比较，在五项RCT中与“未控制”的正常体温进行比较。与正常体温相比，32-34°C的TTM并不能提高生存率（RR：1.06（95%CI 0.94，1.20），P = 0.36；I² = 39%）。在亚组分析中，与“未控制”的正常体温相比，32-34°C的TTM与更好的生存率相关（RR：1.31（95%CI 1.07，1.59），P = 0.008），但与“积极控制”的正常体温相比没有有益效果（RR：0.97（95%CI 0.90，1.04）），P = 0.41）。与正常体温相比，32-34°C的TTM不能改善神经功能结局（RR：1.17（95%CI 0.97，1.41），P = 0.10；I² = 60%）。32-34°C的TTM会增加心律失常的风险（RR：1.35（95%CI 1.16，1.57），P = 0.0001，I² = 0%）。32-34°C的TTM不能改善心脏骤停后的生存率和神经功能结局，反而会增加心律失常的风险。
