Matsumoto Shingo, Kuno Toshiki, Mikami Takahisa, Takagi Hisato, Ikeda Takanori, Briasoulis Alexandros, Bortnick Anna E, Sims Daniel, Katz Jason N, Jentzer Jacob, Bangalore Sripal, Alviar Carlos L
Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Medicine, Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine Bronx, NY.
Am Heart J. 2023 Feb;256:73-84. doi: 10.1016/j.ahj.2022.11.005. Epub 2022 Nov 11.
Targeted temperature management (TTM) has been recommended after cardiac arrest (CA), however the specific temperature targets and cooling methods (intravascular cooling (IVC) versus surface cooling (SC)) remain uncertain.
PUBMED and EMBASE were searched until October 8, 2022 for randomized clinical trials (RCTs) investigating the efficacy of TTM after CA. The randomized treatment arms were categorized into the following 6 groups: 31..C to 33..C IVC, 31..C to 33..C SC, 34..C to 36..C IVC, 34..C to 36..C SC, strict normothermia or fever prevention (Strict NT or FP), and standard of care without TTM (No-TTM). The primary outcome was neurological recovery. P-score was used to rank the treatments, where a larger value indicates better performance.
We identified 15 RCTs, involving 5,218 patients with CA. Compared to No-TTM as the reference, the other therapeutic options significantly improved neurological outcomes (vs No-TTM; 31..C to 33..
RR = 0.67, 95% CI 0.54 to 0.83; 31..C to 33..C SC RR = 0.73, 95% CI 0.61 to 0.87; 34..C to 36..
RR = 0.66, 95% CI 0.51 to 0.86; 34..C to 36..C SC: RR = 0.73, 0.59 to 0.90; Strict NT or FP: RR = 0.75, 95% CI 0.62 to 0.90). Overall, 31-33..C IVC had the highest probability to be the best therapeutic option to improve outcomes (the ranking P-score of 0.836). As a subgroup analysis, the ranking P-score showed that IVC might be a better cooling method compared to SC (IVC vs SC P-score: 0.960 vs 0.670).
Hypothermia (31..C to 36..C IVC and SC) and active normothermia (Strict-NT and Strict-FP) were associated with better neurological outcomes compared to No-TTM, with IVC having a greater probability of being the better cooling method than SC.
心脏骤停（CA）后推荐进行目标温度管理（TTM），然而具体的温度目标和降温方法（血管内降温（IVC）与体表降温（SC））仍不明确。
检索截至2022年10月8日的PUBMED和EMBASE数据库，查找调查CA后TTM疗效的随机临床试验（RCT）。随机治疗组分为以下6组：31℃至33℃ IVC、31℃至33℃ SC、34℃至36℃ IVC、34℃至36℃ SC、严格正常体温或预防发热（严格NT或FP）以及无TTM的标准治疗（无TTM）。主要结局为神经功能恢复。使用P值对治疗进行排名，值越大表明疗效越好。
我们确定了15项RCT，涉及5218例CA患者。与以无TTM作为对照相比，其他治疗方案显著改善了神经功能结局（与无TTM相比；31℃至33℃ IVC：RR = 0.67，95% CI 0.54至0.83；31℃至33℃ SC RR = 0.73，95% CI 0.61至0.87；34℃至36℃ IVC：RR = 0.66，95% CI 0.51至0.86；34℃至36℃ SC：RR = 0.73，0.59至0.90；严格NT或FP：RR = 0.75，95% CI 0.62至0.90）。总体而言，31 - 33℃ IVC最有可能是改善结局的最佳治疗方案（排名P值为0.836）。作为亚组分析，排名P值显示与SC相比，IVC可能是更好的降温方法（IVC与SC的P值：0.960对0.670）。
与无TTM相比，低温（31℃至36℃ IVC和SC）和主动正常体温（严格NT和严格FP）与更好的神经功能结局相关，IVC比SC更有可能是更好的降温方法。
