Médecine Intensive Réanimation, University Hospital Center, Nantes, France.
Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
Chest. 2022 Aug;162(2):356-366. doi: 10.1016/j.chest.2022.02.056. Epub 2022 Mar 19.
Targeted temperature management (TTM) currently is the only treatment with demonstrated efficacy in attenuating the harmful effects on the brain of ischemia-reperfusion injury after cardiac arrest. However, whether TTM is beneficial in the subset of patients with in-hospital cardiac arrest (IHCA) remains unclear.
Is TTM at 33 °C associated with better neurological outcomes after IHCA in a nonshockable rhythm compared with targeted normothermia (TN; 37 °C)?
We performed a post hoc analysis of data from the published Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm randomized controlled trial in 584 patients. We included the 159 patients with IHCA; 73 were randomized to 33 °C treatment and 86 were randomized to 37 °C treatment. The primary outcome was survival with a good neurologic outcome (cerebral performance category [CPC] score of 1 or 2) on day 90. Mixed multivariate adjusted logistic regression analysis was performed to determine whether survival with CPC score of 1 or 2 on day 90 was associated with type of temperature management after adjustment on baseline characteristics not balanced by randomization.
Compared with TN for 48 h, hypothermia at 33 °C for 24 h was associated with a higher percentage of patients who were alive with good neurologic outcomes on day 90 (16.4% vs 5.8%; P = .03). Day 90 mortality was not significantly different between the two groups (68.5% vs 76.7%; P = .24). By mixed multivariate analysis adjusted by Cardiac Arrest Hospital Prognosis score and circulatory shock status, hypothermia was associated significantly with good day 90 neurologic outcomes (OR, 2.40 [95% CI, 1.17-13.03]; P = .03).
Hypothermia at 33 °C was associated with better day 90 neurologic outcomes after IHCA in a nonshockable rhythm compared with TN. However, the limited sample size resulted in wide CIs. Further studies of patients after cardiac arrest resulting from any cause, including IHCA, are needed.
目标温度管理（TTM）目前是唯一被证明能减轻心脏骤停后缺血再灌注损伤对大脑有害影响的治疗方法。然而，在院内心脏骤停（IHCA）患者亚组中，TTM 是否有益仍不清楚。
与目标正常体温（TN；37°C）相比，33°C 的 TTM 是否与非可电击节律的 IHCA 后更好的神经结局相关？
我们对已发表的非可电击节律心脏骤停的目标温度管理试验中的数据进行了事后分析，该试验纳入了 584 名患者。我们纳入了 159 名 IHCA 患者；73 名患者被随机分配到 33°C 治疗组，86 名患者被随机分配到 37°C 治疗组。主要结局是 90 天时存活且神经功能良好（脑功能分类[CPC]评分 1 或 2）。采用混合多变量调整逻辑回归分析，确定在调整基线特征后，90 天时 CPC 评分 1 或 2 的存活是否与温度管理类型相关，这些特征未通过随机分配达到平衡。
与 48 小时 TN 相比，24 小时 33°C 低温与 90 天时存活且神经功能良好的患者比例更高（16.4%比 5.8%；P=.03）。两组之间第 90 天死亡率无显著差异（68.5%比 76.7%；P=.24）。通过按心脏骤停医院预后评分和循环休克状态调整的混合多变量分析，低温与 90 天的良好神经结局显著相关（OR，2.40[95%CI，1.17-13.03]；P=.03）。
与 TN 相比，非可电击节律的 IHCA 患者中，33°C 的低温与 90 天时更好的神经结局相关。然而，由于样本量有限，置信区间较宽。需要进一步研究任何原因导致的心脏骤停后患者，包括 IHCA。
