体外膜肺氧合治疗的院外心脏骤停患者不同目标温度对预后的影响：一项全国性队列研究。

The impact of different targeted temperatures on out-of-hospital cardiac arrest outcomes in patients receiving extracorporeal membrane oxygenation: a nationwide cohort study.

机构信息

Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.

Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.

出版信息

Crit Care. 2022 Dec 8;26(1):380. doi: 10.1186/s13054-022-04256-x.

DOI:10.1186/s13054-022-04256-x

PMID:36482479

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9733046/

Abstract

BACKGROUND

Targeted temperature management (TTM) is recommended in the management of out-of-hospital cardiac arrest (OHCA) when coma persists after the return of spontaneous circulation. In the setting of extracorporeal membrane oxygenation (ECMO) for OHCA patients, TTM is associated with good neurological outcomes and is recommended in the Extracorporeal Life Support Organization guidelines. However, the optimal targeted temperature for these patients has not yet been adequately investigated. This study aimed to compare the impact of different targeted temperatures on the outcomes in OHCA patients receiving ECMO.

METHODS

This was a retrospective analysis of data from the Japanese Association for Acute Medicine (JAAM)-OHCA Registry, a multicentre nationwide prospective database in Japan in which 103 institutions providing emergency care participated. OHCA patients aged ≥ 18 years who required ECMO with TTM between June 2014 and December 2019 were included in our analysis. The primary outcome was 30-day survival with favourable neurological outcomes, defined as a Glasgow-Pittsburgh cerebral performance category score of 1 or 2. Patients were divided into two groups according to their targeted temperature: normothermic TTM (n-TTM) (35-36 °C) and hypothermic TTM (h-TTM) (32-34 °C). We compared the outcomes between the two targeted temperature groups using multivariable logistic regression and inverse probability weighting (IPW).

RESULTS

A total of 890 adult OHCA patients who received ECMO and TTM were eligible for our analysis. Of these patients, 249 (28%) and 641 (72%) were treated with n-TTM and h-TTM, respectively. The proportions of patients with 30-day favourable neurological outcomes were 16.5% (41/249) and 15.9% (102/641), in the n-TTM and h-TTM groups, respectively. No difference in neurological outcomes was observed in the multiple regression analysis [adjusted odds ratio 0.91, 95% confidence interval (CI) 0.58-1.43], and the result was constant in the IPW (odds ratio 1.01, 95% CI 0.67-1.54).

CONCLUSION

No difference was observed between n-TTM and h-TTM in OHCA patients receiving TTM with ECMO. The current understanding that changes to the targeted temperature have little impact on the outcome of patients may remain true regardless of ECMO use.

摘要

背景

在院外心脏骤停（OHCA）患者自主循环恢复后持续昏迷时，建议进行目标温度管理（TTM）。在 OHCA 患者体外膜肺氧合（ECMO）的情况下，TTM 与良好的神经结局相关，并且在体外生命支持组织指南中推荐使用。然而，这些患者的最佳目标温度尚未得到充分研究。本研究旨在比较 ECMO 治疗的 OHCA 患者中不同目标温度对结局的影响。

方法

这是一项对日本急救医学协会（JAAM）-OHCA 注册中心数据的回顾性分析，该注册中心是日本一个多中心全国性前瞻性数据库，有 103 家提供急救护理的机构参与。本分析纳入了 2014 年 6 月至 2019 年 12 月期间接受 ECMO 和 TTM 的年龄≥18 岁的 OHCA 患者。主要结局是 30 天生存且神经功能良好，定义为格拉斯哥-匹兹堡脑功能表现分类评分 1 或 2 分。患者根据目标温度分为两组：常规 TTM（n-TTM）（35-36°C）和低温 TTM（h-TTM）（32-34°C）。我们使用多变量逻辑回归和逆概率加权（IPW）比较了两组的结局。

结果

共有 890 名接受 ECMO 和 TTM 的成年 OHCA 患者符合本分析条件。这些患者中，249 名（28%）和 641 名（72%）接受 n-TTM 和 h-TTM 治疗。n-TTM 和 h-TTM 组的 30 天神经功能良好结局比例分别为 16.5%（41/249）和 15.9%（102/641）。多回归分析未观察到神经结局差异[调整后的优势比 0.91，95%置信区间（CI）0.58-1.43]，且在 IPW 中结果一致（优势比 1.01，95%CI 0.67-1.54）。