欧洲复苏委员会-欧洲危重病医学会成人心脏骤停后体温管理指南。

ERC-ESICM guidelines on temperature control after cardiac arrest in adults.

机构信息

University of Warwick, Warwick Medical School, Coventry CV4 7AL, UK; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath BA1 3NG, UK.

Department of Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.

出版信息

Resuscitation. 2022 Mar;172:229-236. doi: 10.1016/j.resuscitation.2022.01.009. Epub 2022 Feb 4.

Abstract

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research. The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 hours. There was insufficient evidence to recommend for or against temperature control at 32-36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.

摘要

这些指南的目的是为心脏停搏后从院内或院外复苏的昏迷成人提供基于证据的体温控制指导,无论基础心律如何。这些指南取代了 2021 年复苏后护理指南中关于心脏停搏后体温管理的建议,该指南由欧洲复苏理事会(ERC)和欧洲危重病医学会(ESICM)共同发布。指南小组包括 13 名撰写 2021 年 ERC-ESICM 指南的国际临床专家和 2 名代表国际复苏联合会(ILCOR)参与证据审查的方法学家,ERC 是其成员协会。我们遵循推荐评估、制定和评估(GRADE)方法来评估证据的确定性并对建议进行分级。小组就指南的实施提出了建议,并确定了未来研究的优先事项。证据的确定性从中等到低不等。在心脏停搏后仍处于昏迷状态的患者中,我们建议持续监测核心体温并积极预防发热(定义为体温>37.7°C)至少 72 小时。没有足够的证据推荐或反对 32-36°C 的体温控制或心脏停搏后早期降温。我们建议不要在自主循环恢复(ROSC)后主动使轻度低体温的昏迷患者复温以达到正常体温。我们建议不要在 ROSC 后立即使用院前降温,通过快速输注大量冷静脉液体。

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