Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan.
BMC Emerg Med. 2022 May 14;22(1):84. doi: 10.1186/s12873-022-00641-5.
The association between spontaneous initial body temperature on hospital arrival and neurological outcomes has not been sufficiently studied in patients after out-of-hospital cardiac arrest (OHCA).
From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all patients with OHCA of medical origin aged > 18 years for whom resuscitation was attempted and who were transported to participating hospitals between 2012 and 2019. We excluded patients who were not witnessed by bystanders and treated by a doctor car or helicopter, which is a car/helicopter with a physician. The patients were categorized into three groups according to their temperature on hospital arrival: ≤35.9 °C, 36.0-36.9 °C (normothermia), and ≥ 37.0 °C. The primary outcome was 1-month survival, with a cerebral performance category of 1 or 2. Multivariable logistic regression analyses were performed to evaluate the association between temperature and outcomes (normothermia was used as the reference). We also assessed this association using cubic spline regression analysis.
Of the 18,379 patients in our database, 5014 witnessed adult OHCA patients of medical origin from 16 hospitals were included. When analyzing 3318 patients, OHCA patients with an initial body temperature of ≥37.0 °C upon hospital arrival were associated with decreased favorable neurological outcomes (6.6% [19/286] odds ratio, 0.51; 95% confidence interval, 0.27-0.95) compared to patients with normothermia (16.4% [180/1100]), whereas those with an initial body temperature of ≤35.9 °C were not associated with decreased favorable neurological outcomes (11.1% [214/1932]; odds ratio, 0.78; 95% confidence interval, 0.56-1.07). The cubic regression splines demonstrated that a higher body temperature on arrival was associated with decreased favorable neurological outcomes, and a lower body temperature was not associated with decreased favorable neurological outcomes.
In adult patients with OHCA of medical origin, a higher body temperature on arrival was associated with decreased favorable neurologic outcomes.
在院外心脏骤停（OHCA）后患者中，体温与神经结局之间的关联尚未得到充分研究。
我们从日本大阪综合 ICU 生存 OHCA 登记研究（CRITICAL）的前瞻性数据库中纳入了所有年龄大于 18 岁、尝试复苏并在 2012 年至 2019 年期间被转运至参与医院的 OHCA 患者，这些患者的病因均为医学原因，且为旁观者目击，并由医生车或直升机进行治疗（配备医生的车辆/直升机）。根据入院时的体温，将患者分为三组：≤35.9°C、36.0-36.9°C（正常体温）和≥37.0°C。主要结局为 1 个月生存率，采用格拉斯哥预后评分 1 或 2 分。采用多变量逻辑回归分析评估体温与结局之间的关联（正常体温作为参考）。我们还使用三次样条回归分析评估了这种关联。
在我们的数据库中，纳入了来自 16 家医院的 18379 例目击成人 OHCA 患者中，5014 例患者为医学原因所致。在分析 3318 例患者时，与正常体温组（16.4%[180/1100]）相比，入院时体温≥37.0°C 的 OHCA 患者，其神经结局不良（6.6%[286/19]，优势比 0.51；95%置信区间，0.27-0.95）的几率降低，而体温≤35.9°C 的患者神经结局不良的几率未降低（11.1%[1932/214]；优势比 0.78；95%置信区间，0.56-1.07）。三次回归样条显示，入院时体温较高与神经结局不良降低相关，而体温较低与神经结局不良降低无关。
在 OHCA 病因源于医学原因的成年患者中，入院时体温较高与神经结局不良降低相关。
