Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada.
Department of Critical Care, Schulich School Medicine & Dentistry, Western University, London, ON, Canada.
Can J Anaesth. 2024 May;71(5):629-639. doi: 10.1007/s12630-024-02737-x. Epub 2024 Mar 21.
Core body temperature has been extensively investigated as a thereuptic target in care after cardiac arrest. Nevertheless, the integrity of thermoregulation in patients after cardiac arrest has not been well studied. We sought to evaluate whether low spontaneous body temperature after cardiac arrest is associated with increased death and a worse neurologic outcome, and whether patients with low spontaneous body temperature exhibit features suggestive of impaired thermoregulation.
We conducted a single-centre retrospective cohort study. We included all adult patients who underwent temperature control with hypothermia after cardiac arrest between 1 January 2014 and 30 June 2020. The primary exposure was low spontaneous core body temperature (< 35 °C) at initiation of hypothermia therapy. The primary outcome was in-hospital death and the secondary outcome was poor neurologic outcomes at discharge.
Five hundred and ninety-seven adult patients, comprising both in- and out-of-hospital cardiac arrests, were included. Patients with low spontaneous body temperature also had slightly lower average temperature, and more frequent transient but controlled breakthrough fever episodes in the first 24 hr. In the multivariable logistic regression analysis, low spontaneous body temperature was associated with higher odds of in-hospital death (odds ratio, 2.9; 95% confidence interval, 1.9 to 4.2; P < 0.001).
In this single-centre retrospective cohort study, low spontaneous core body temperature was associated with poor outcomes in patients after cardiac arrest. Patients with low spontaneous body temperature also exhibited features suggestive of impaired thermoregulation. Further research is needed to determine whether body temperature upon presentation reflects the robustness of the patient's underlying physiology and severity of brain insult after a cardiac arrest.
核心体温已被广泛研究作为心脏骤停后治疗的治疗靶点。然而，心脏骤停后患者体温调节的完整性尚未得到很好的研究。我们旨在评估心脏骤停后自发低体温是否与死亡率增加和神经功能预后较差相关，以及低自发体温的患者是否表现出体温调节受损的特征。
我们进行了一项单中心回顾性队列研究。我们纳入了 2014 年 1 月 1 日至 2020 年 6 月 30 日期间接受低温治疗的所有成年心脏骤停患者。主要暴露因素为低温治疗开始时自发核心体温<35℃。主要结局为院内死亡，次要结局为出院时神经功能预后不良。
共纳入 597 例成人患者，包括院内和院外心脏骤停患者。低自发体温的患者体温也略低，在最初 24 小时内更频繁地出现短暂但可控的突破性发热发作。多变量逻辑回归分析显示，低自发体温与院内死亡的几率较高相关（比值比，2.9；95%置信区间，1.9 至 4.2；P<0.001）。
在这项单中心回顾性队列研究中，心脏骤停后患者的自发核心体温较低与不良结局相关。低自发体温的患者还表现出体温调节受损的特征。需要进一步研究以确定入院时的体温是否反映了患者基础生理的稳健性和心脏骤停后大脑损伤的严重程度。
