Shiber Joseph, Fontane Emily
University of Florida College of Medicine, Jacksonville, FL USA.
J Crit Care Med (Targu Mures). 2023 Feb 8;9(1):39-42. doi: 10.2478/jccm-2023-0004. eCollection 2023 Jan.
Despite the decreased survival associated with diabetes with out-of-hospital cardiac arrest and the overall low survival to hospital discharge, we would like to present two cases of OHCA in diabetics who despite prolonged resuscitation efforts had complete neurological recovery likely due to concomitant hypothermia. There is a steady decreasing rate of ROSC with longer durations of CPR so that outcomes are best when <20 minutes compared to prolonged resuscitation efforts (>30-40 minutes). It has been previously recognized that hypothermia prior to cardiac arrest can be neurologically protective even with up to 9 hours of cardiopulmonary resuscitation. Hypothermia has been associated with DKA and although often indicates sepsis with mortality rates of 30-60%, it may indeed be protective if occurring prior to cardiac arrest. The critical factor for neuroprotection may be a slow drop to a temperature <25C prior to OHCA as is achieved in deep hypothermic circulatory arrest for operative procedures of the aortic arch and great vessels. It may be worthwhile continuing aggressive resuscitation efforts even for prolonged periods before attaining ROSC for OHCA in patients found hypothermic from metabolic illnesses as compared to only from environmental exposures (avalanche victims, cold water submersions, etc.) as has been traditionally reported in the medical literature.
尽管糖尿病患者院外心脏骤停后的生存率有所下降，且总体出院生存率较低，但我们想介绍两例糖尿病患者的院外心脏骤停病例，尽管进行了长时间的复苏努力，但由于伴有低温，他们仍实现了完全神经功能恢复。随着心肺复苏时间延长，自主循环恢复（ROSC）率稳步下降，因此与长时间复苏努力（>30 - 40分钟）相比，心肺复苏时间<20分钟时预后最佳。此前已认识到，心脏骤停前的低温即使在长达9小时的心肺复苏情况下也可能具有神经保护作用。低温与糖尿病酮症酸中毒（DKA）有关，虽然它通常提示脓毒症，死亡率为30% - 60%，但如果在心脏骤停前发生，它可能确实具有保护作用。神经保护的关键因素可能是在院外心脏骤停前缓慢降至<25℃的体温，就像在主动脉弓和大血管手术的深低温停循环中所达到的那样。与传统医学文献报道的仅因环境暴露（雪崩受害者、冷水浸没等）导致低温的患者相比，对于因代谢性疾病导致低温的院外心脏骤停患者，即使在长时间未实现ROSC之前，继续进行积极的复苏努力可能也是值得的。
