Sugiyama Kana, Nomura Osamu, Irie Jin, Ishizawa Yoshiya, Takauji Shuhei, Hayakawa Mineji, Tamada Yoshinori, Hanada Hiroyuki
Department of Emergency and Disaster Medicine, Hirosaki University, 5, Zaifu-cho, Hirosaki 036-8562, Japan.
Department of Health Sciences Education, Hirosaki University, 5, Zaifu-cho, Hirosaki 036-8562, Japan.
Am J Emerg Med. 2024 May;79:91-96. doi: 10.1016/j.ajem.2024.02.014. Epub 2024 Feb 15.
Rewarming therapies for accidental hypothermia (AH) include extracorporeal membrane oxygenation (ECMO) and non-ECMO related (conventional) therapies. However, there are limited data available to inform the selection of conventional rewarming therapy. The aim of the present study was to explore what patients' factors and which rewarming therapy predicted favorable prognosis.
This study is a secondary analysis of the Intensive Care with Extra Corporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study, a multicenter prospective, observational study conducted in Japan. Enrolled in the ICE-CRASH study were patients aged ≥18 years with a core temperature of ≤32 °C who were transported to the emergency departments of 36 tertiary care hospitals in Japan between 1 December 2019 and 31 March 2022, among whom those who were rewarmed with conventional rewarming therapy were included in the present study. Logistic regression analysis was performed with 28-day survival as the objective variable; and seven factors including age, activities of daily living (ADL) independence, sequential organ failure assessment (SOFA) score, and each rewarming technique as explanatory variables. We performed linear regression analysis to identify whether each rewarming technique was associated with rewarming rate.
Of the 499 patients enrolled in the ICE-CRASH study, 371 were eligible for this secondary analysis. The median age was 81 years, 50.9% were male, and the median initial body temperature was 28.8 °C. Age (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.94-1.00) and SOFA score (OR: 0.73, 95% CI: 0.67-0.81) were associated with lower survival, whereas ADL independence (OR: 2.31, 95% CI: 1.15-4.63) was associated with higher survival. No conventional rewarming therapy was associated with 28-day survival. Hot bath was associated with a high rewarming rate (regression coefficient: 1.14, 95% CI: 0.75-1.53).
No conventional rewarming therapy was associated with improved 28-day survival, which suggests that background factors such as age, ADL, and severity of condition contribute more to prognosis than does the selection of rewarming technique.
意外低温（AH）的复温疗法包括体外膜肺氧合（ECMO）和非ECMO相关（传统）疗法。然而，关于选择传统复温疗法的可用数据有限。本研究的目的是探讨哪些患者因素和哪种复温疗法可预测良好预后。
本研究是对重度意外低温体外膜肺氧合复温强化治疗（ICE-CRASH）研究的二次分析，这是一项在日本进行的多中心前瞻性观察性研究。ICE-CRASH研究纳入了年龄≥18岁、核心体温≤32°C且于2019年12月1日至2022年3月31日期间被送往日本36家三级医院急诊科的患者，其中采用传统复温疗法进行复温的患者被纳入本研究。以28天生存率作为目标变量进行逻辑回归分析；以年龄、日常生活活动（ADL）独立性、序贯器官衰竭评估（SOFA）评分以及每种复温技术等七个因素作为解释变量。我们进行线性回归分析以确定每种复温技术是否与复温速率相关。
在ICE-CRASH研究纳入的499例患者中，371例符合本次二次分析的条件。中位年龄为81岁，50.9%为男性，初始体温中位数为28.8°C。年龄（比值比[OR]：0.97，95%置信区间[CI]：0.94 - 1.00）和SOFA评分（OR：0.73，95% CI：0.67 - 0.81）与较低的生存率相关，而ADL独立性（OR：2.31，95% CI：1.15 - 4.63）与较高的生存率相关。没有传统复温疗法与28天生存率相关。热水浴与较高的复温速率相关（回归系数：1.14，95% CI：0.75 - 1.53）。
没有传统复温疗法与28天生存率的改善相关，这表明年龄、ADL和病情严重程度等背景因素对预后的影响比复温技术的选择更大。
