Luedke Matthew William, Graffagnino Carmelo, McKinney B Grace, Piper Jill, Iversen Edwin, Kolls Brad
Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA.
Duke University Medical Center, Durham, North Carolina, USA.
BMJ Neurol Open. 2022 Apr 18;4(1):e000273. doi: 10.1136/bmjno-2022-000273. eCollection 2022.
BACKGROUND/PURPOSE: Cardiac arrest is a common cause of death and neurological injury; therapeutic cooling for neuroprotection is standard of care. Despite numerous and ongoing trials targeting a specified cooling temperature for a target duration, the concept of temperature dose-the duration spent at a given depth of hypothermia-is not as well explored.
In this retrospective study, we examined 66 patients 18 years of age or older undergoing therapeutic hypothermia for cardiac arrest between 2007 and 2010 to assess the relationship of temperature dose with outcomes. Demographic, clinical, outcome and temperature data were collected. Demographic and clinical data underwent bivariate regression analysis for association with outcome. Time-temperature curves were divided into pre-determined temperature thresholds and assessed by logistic regression analysis for association with outcome. A second, multivariate regression analysis was performed controlling for factors associated with poor outcomes.
Old age was significantly associated with poor outcome and a shockable arrest rhythm was significantly associated with positive outcome. Subjects spent an average of 2.82 hours below 35°C, 7.31 hours ≥35°C to ≤36.5°C, 24.75 hours >36.5 to <38.0°C and 7.06 hours ≥38°C. Logistic regression analysis revealed borderline significant positive association between good outcome and time at a cooling depth (35°C-36.5°C, p=0.05); adjusted for old age, the association became significant (p=0.04).
Controlling for old age, longer durations between >35°C, ≤36.5°C during therapeutic hypothermia for cardiac arrest were significantly associated with good clinical outcomes. Time spent within a given temperature range may be useful for measuring the effect of temperature management.
背景/目的：心脏骤停是死亡和神经损伤的常见原因；用于神经保护的治疗性低温是护理标准。尽管有许多正在进行的试验针对特定的降温温度和目标持续时间，但温度剂量的概念——在给定低温深度下所花费的持续时间——尚未得到充分研究。
在这项回顾性研究中，我们检查了2007年至2010年间66例18岁及以上因心脏骤停接受治疗性低温的患者，以评估温度剂量与预后的关系。收集了人口统计学、临床、预后和温度数据。对人口统计学和临床数据进行双变量回归分析以确定与预后的关联。将时间-温度曲线划分为预先确定的温度阈值，并通过逻辑回归分析评估与预后的关联。进行了第二次多变量回归分析，以控制与不良预后相关的因素。
高龄与不良预后显著相关，可电击心律与良好预后显著相关。受试者在35°C以下平均花费2.82小时，在35°C至36.5°C之间≥7.31小时，在36.5°C至38.0°C之间>24.75小时，在38°C及以上≥7.06小时。逻辑回归分析显示，良好预后与降温深度（35°C - 36.5°C）下的时间之间存在临界显著正相关（p = 0.05）；调整年龄后，这种关联变得显著（p = 0.04）。
在控制年龄的情况下，心脏骤停治疗性低温期间在35°C至36.5°C之间的较长持续时间与良好的临床预后显著相关。在给定温度范围内花费的时间可能有助于衡量温度管理的效果。
