Ziriat Ines, Le Thuaut Aurélie, Colin Gwenhael, Merdji Hamid, Grillet Guillaume, Girardie Patrick, Souweine Bertrand, Dequin Pierre-François, Boulain Thierry, Frat Jean-Pierre, Asfar Pierre, Francois Bruno, Landais Mickael, Plantefeve Gaëtan, Quenot Jean-Pierre, Chakarian Jean-Charles, Sirodot Michel, Legriel Stéphane, Massart Nicolas, Thevenin Didier, Desachy Arnaud, Delahaye Arnaud, Botoc Vlad, Vimeux Sylvie, Martino Frederic, Reignier Jean, Cariou Alain, Lascarrou Jean Baptiste
Médecine Intensive Réanimation, University Hospital Centre, Nantes, France.
Direction de la Recherche Clinique et l'Innovation, Plateforme de Méthodologie et Biostatistique, University Hospital Centre, Nantes, France.
Ann Intensive Care. 2022 Oct 17;12(1):96. doi: 10.1186/s13613-022-01071-z.
Outcomes of postresuscitation shock after cardiac arrest can be affected by targeted temperature management (TTM). A post hoc analysis of the "TTM1 trial" suggested higher mortality with hypothermia at 33 °C. We performed a post hoc analysis of HYPERION trial data to assess potential associations linking postresuscitation shock after non-shockable cardiac arrest to hypothermia at 33 °C on favourable functional outcome.
We divided the patients into groups with vs. without postresuscitation (defined as the need for vasoactive drugs) shock then assessed the proportion of patients with a favourable functional outcome (day-90 Cerebral Performance Category [CPC] 1 or 2) after hypothermia (33 °C) vs. controlled normothermia (37 °C) in each group. Patients with norepinephrine or epinephrine > 1 µg/kg/min were not included.
Of the 581 patients included in 25 ICUs in France and who did not withdraw consent, 339 had a postresuscitation shock and 242 did not. In the postresuscitation-shock group, 159 received hypothermia, including 14 with a day-90 CPC of 1-2, and 180 normothermia, including 10 with a day-90 CPC of 1-2 (8.81% vs. 5.56%, respectively; P = 0.24). After adjustment, the proportion of patients with CPC 1-2 also did not differ significantly between the hypothermia and normothermia groups (adjusted hazards ratio, 1.99; 95% confidence interval, 0.72-5.50; P = 0.18). Day-90 mortality was comparable in these two groups (83% vs. 86%, respectively; P = 0.43).
After non-shockable cardiac arrest, mild-to-moderate postresuscitation shock at intensive-care-unit admission did not seem associated with day-90 functional outcome or survival. Therapeutic hypothermia at 33 °C was not associated with worse outcomes compared to controlled normothermia in patients with postresuscitation shock. Trial registration ClinicalTrials.gov, NCT01994772.
心脏骤停后复苏后休克的结局可能受目标温度管理（TTM）影响。“TTM1试验”的事后分析表明，33℃低温会导致更高的死亡率。我们对HYPERION试验数据进行了事后分析，以评估非可电击性心脏骤停后复苏后休克与33℃低温对良好功能结局的潜在关联。
我们将患者分为有或无复苏后（定义为需要血管活性药物）休克的组，然后评估每组中低温（33℃）与控制正常体温（37℃）后功能结局良好（第90天脑功能分类[CPC]为1或2）的患者比例。不包括去甲肾上腺素或肾上腺素>1μg/kg/min的患者。
在法国25个重症监护病房纳入的581例未撤回同意的患者中，339例有复苏后休克，242例没有。在复苏后休克组中，159例接受了低温治疗，其中14例第90天CPC为１-2，180例接受正常体温治疗，其中10例第90天CPC为1-2（分别为8.81%和5.56%；P=0.24）。调整后，低温组和正常体温组中CPC为1-2的患者比例也无显著差异（调整后的风险比为1.99；95%置信区间为0.72-5.50；P=0.18）。这两组第90天的死亡率相当（分别为83%和86%；P=0.43）。
非可电击性心脏骤停后，重症监护病房入院时的轻至中度复苏后休克似乎与第90天的功能结局或生存率无关。与复苏后休克患者的控制正常体温相比，33℃治疗性低温与更差的结局无关。试验注册ClinicalTrials.gov，NCT01994772。
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