Watanabe Makoto, Matsuyama Tasuku, Oe Hikaru, Sasaki Makoto, Nakamura Yuki, Miyamoto Yuki, Okada Nobunaga, Kitamura Tetsuhisa, Ohta Bon
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Ann Intensive Care. 2021 Nov 26;11(1):163. doi: 10.1186/s13613-021-00953-y.
Little is known about the effectiveness of surface cooling (SC) and endovascular cooling (EC) on the outcome of out-of-hospital cardiac arrest (OHCA) patients receiving target temperature management (TTM) according to their initial rhythm.
We retrospectively analysed data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a multicentre, prospective nationwide database in Japan. For our analysis, OHCA patients aged ≥ 18 years who were treated with TTM between June 2014 and December 2017 were included. The primary outcome was 30-day survival with favourable neurological outcome defined as a Glasgow-Pittsburgh cerebral performance category score of 1 or 2. Cooling methods were divided into the following groups: SC (ice packs, fans, air blankets, and surface gel pads) and EC (endovascular catheters and any dialysis technique). We investigated the efficacy of the two categories of cooling methods in two different patient groups divided according to their initially documented rhythm at the scene (shockable or non-shockable) using multivariable logistic regression analysis and propensity score analysis with inverse probability weighting (IPW).
In the final analysis, 1082 patients were included. Of these, 513 (47.4%) had an initial shockable rhythm and 569 (52.6%) had an initial non-shockable rhythm. The proportion of patients with favourable neurological outcomes in SC and EC was 59.9% vs. 58.3% (264/441 vs. 42/72), and 11.8% (58/490) vs. 21.5% (17/79) in the initial shockable patients and the initial non-shockable patients, respectively. In the multivariable logistic regression analysis, differences between the two cooling methods were not observed among the initial shockable patients (adjusted odd ratio [AOR] 1.51, 95% CI 0.76-3.03), while EC was associated with better neurological outcome among the initial non-shockable patients (AOR 2.21, 95% CI 1.19-4.11). This association was constant in propensity score analysis with IPW (OR 1.40, 95% CI 0.83-2.36; OR 1.87, 95% CI 1.01-3.47 among the initial shockable and non-shockable patients, respectively).
We suggested that the use of EC was associated with better neurological outcomes in OHCA patients with initial non-shockable rhythm, but not in those with initial shockable rhythm. A TTM implementation strategy based on initial rhythm may be important.
关于体表降温（SC）和血管内降温（EC）对接受目标温度管理（TTM）的院外心脏骤停（OHCA）患者根据其初始心律的预后效果，目前所知甚少。
我们回顾性分析了日本急性医学协会院外心脏骤停登记处的数据，这是一个日本全国性的多中心前瞻性数据库。在我们的分析中，纳入了2014年6月至2017年12月期间接受TTM治疗的年龄≥18岁的OHCA患者。主要结局是30天存活且神经功能良好，定义为格拉斯哥 - 匹兹堡脑功能分类评分为1或2。降温方法分为以下几组：SC（冰袋、风扇、空气毯和体表凝胶垫）和EC（血管内导管和任何透析技术）。我们使用多变量逻辑回归分析和倾向评分分析及逆概率加权（IPW），研究了这两类降温方法在根据现场最初记录的心律分为可电击心律或不可电击心律的两个不同患者组中的疗效。
在最终分析中，纳入了1082例患者。其中，513例（47.4%）初始心律为可电击心律，569例（52.6%）初始心律为不可电击心律。SC组和EC组神经功能良好患者的比例分别为59.9%对58.3%（264/441对42/72），初始可电击心律患者中为11.8%（58/490），初始不可电击心律患者中为21.5%（17/79）。在多变量逻辑回归分析中，初始可电击心律患者中未观察到两种降温方法之间的差异（调整后的比值比[AOR]为1.51，95%置信区间为0.76 - 3.03），而在初始不可电击心律患者中，EC与更好的神经功能结局相关（AOR为2.21，95%置信区间为1.19 - 4.11）。在使用IPW的倾向评分分析中，这种关联是恒定的（初始可电击心律和不可电击心律患者中，OR分别为1.40，95%置信区间为0.83 - 2.36；OR为1.87，95%置信区间为1.01 - 3.47）。
我们认为，对于初始心律为不可电击心律的OHCA患者，使用EC与更好的神经功能结局相关，但对于初始心律为可电击心律的患者则不然。基于初始心律的TTM实施策略可能很重要。
