School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Medicine, Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan.
Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Am J Emerg Med. 2023 Sep;71:182-189. doi: 10.1016/j.ajem.2023.06.040. Epub 2023 Jun 28.
Targeted temperature management (TTM) with therapeutic hypothermia (TH) has been used to improve neurological outcomes in patients after cardiac arrest; however, several trials have reported conflicting results regarding its effectiveness. This systematic review and meta-analysis assessed whether TH was associated with better survival and neurological outcomes after cardiac arrest.
We searched online databases for relevant studies published before May 2023. Randomized controlled trials (RCTs) comparing TH and normothermia in post-cardiac-arrest patients were selected. Neurological outcomes and all-cause mortality were assessed as the primary and secondary outcomes, respectively. A subgroup analysis according to initial electrocardiography (ECG) rhythm was performed.
Nine RCTs (4058 patients) were included. The neurological prognosis was significantly better in patients with an initial shockable rhythm after cardiac arrest (RR = 0.87, 95% confidence interval [CI] = 0.76-0.99, P = 0.04), especially in those with earlier TH initiation (<120 min) and prolonged TH duration (≥24 h). However, the mortality rate after TH was not lower than that after normothermia (RR = 0.91, 95% CI = 0.79-1.05). In patients with an initial nonshockable rhythm, TH did not provide significantly more neurological or survival benefits (RR = 0.98, 95% CI = 0.93-1.03 and RR = 1.00, 95% CI = 0.95-1.05, respectively).
Current evidence with a moderate level of certainty suggests that TH has potential neurological benefits for patients with an initial shockable rhythm after cardiac arrest, especially in those with faster TH initiation and longer TH maintenance.
目标温度管理（TTM）联合治疗性低体温（TH）已被用于改善心搏骤停后患者的神经功能预后；然而，一些试验报告其有效性结果存在矛盾。本系统评价和荟萃分析评估了 TH 是否与心搏骤停后患者的生存和神经功能预后改善相关。
我们检索了截至 2023 年 5 月发表的在线数据库中相关研究。选择比较心搏骤停后患者 TH 与常温治疗的随机对照试验（RCT）。分别将神经功能结局和全因死亡率作为主要结局和次要结局进行评估。还进行了根据初始心电图（ECG）节律的亚组分析。
纳入了 9 项 RCT（4058 例患者）。心搏骤停后初始为可除颤节律的患者神经预后明显更好（RR=0.87，95%置信区间[CI]：0.76-0.99，P=0.04），尤其是 TH 起始时间更早（＜120 分钟）和 TH 持续时间更长（≥24 小时）的患者。然而，TH 后死亡率并不低于常温治疗（RR=0.91，95%CI：0.79-1.05）。初始为不可除颤节律的患者中，TH 并未提供显著更多的神经或生存获益（RR=0.98，95%CI：0.93-1.03 和 RR=1.00，95%CI：0.95-1.05）。
目前有中等确定性证据表明，TH 对心搏骤停后初始为可除颤节律的患者具有潜在的神经获益，尤其是在更快启动 TH 和更长时间维持 TH 的患者中。
