Callaway Clifton W
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Clin Exp Emerg Med. 2023 Mar;10(1):5-17. doi: 10.15441/ceem.23.012. Epub 2023 Feb 16.
Targeted temperature management with mild hypothermia (TTM-hypothermia; 32-34 °C) is a treatment strategy for adult patients who are comatose after cardiac arrest. Robust preclinical data support the beneficial effects of hypothermia beginning within 4 hours of reperfusion and maintained during the several days of postreperfusion brain dysregulation. TTM-hypothermia increased survival and functional recovery after adult cardiac arrest in several trials and in realworld implementation studies. TTM-hypothermia also benefits neonates with hypoxic-ischemic brain injury. However, larger and methodologically more rigorous adult trials do not detect benefit. Reasons for inconsistency of adult trials include the difficulty delivering differential treatment between randomized groups within 4 hours and the use of shorter durations of treatment. Furthermore, adult trials enrolled populations that vary in illness severity and brain injury, with individual trials enriched for higher or lower illness severity. There are interactions between illness severity and treatment effect. Current data indicate that TTM-hypothermia implemented quickly for adult patients after cardiac arrest, may benefit select patients at risk of severe brain injury but not benefit other patients. More data are needed on how to identify treatment-responsive patients and on how to titrate the timing and duration of TTM-hypothermia.
轻度低温目标温度管理（TTM-低温；32-34°C）是心脏骤停后昏迷成年患者的一种治疗策略。有力的临床前数据支持在再灌注后4小时内开始并在再灌注后脑功能失调的数天内维持低温的有益效果。在多项试验和实际应用研究中，TTM-低温提高了成年心脏骤停后的生存率和功能恢复。TTM-低温对患有缺氧缺血性脑损伤的新生儿也有益。然而，规模更大且方法更严谨的成年试验未发现益处。成年试验结果不一致的原因包括在4小时内在随机分组之间进行差异治疗存在困难以及治疗持续时间较短。此外，成年试验纳入的人群疾病严重程度和脑损伤各不相同，个别试验纳入的患者疾病严重程度较高或较低。疾病严重程度和治疗效果之间存在相互作用。目前的数据表明，心脏骤停后成年患者迅速实施TTM-低温，可能使有严重脑损伤风险的特定患者受益，但对其他患者无益处。关于如何识别对治疗有反应的患者以及如何调整TTM-低温的时机和持续时间，还需要更多数据。
