Tamura Tomoyoshi, Narumiya Hiromichi, Homma Koichiro, Suzuki Masaru
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
Center for Molecular Hydrogen Medicine, Keio University, Minato City, Tokyo, Japan.
Crit Care Med. 2024 Oct 1;52(10):1567-1576. doi: 10.1097/CCM.0000000000006395. Epub 2024 Aug 12.
OBJECTIVE: The Efficacy of Inhaled Hydrogen on Neurologic Outcome Following Brain Ischemia During Post-Cardiac Arrest Care (HYBRID) II trial (jRCTs031180352) suggested that hydrogen inhalation may reduce post-cardiac arrest brain injury (PCABI). However, the combination of hypothermic target temperature management (TTM) and hydrogen inhalation on outcomes is unclear. The aim of this study was to investigate the combined effect of hydrogen inhalation and hypothermic TTM on outcomes after out-of-hospital cardiac arrest (OHCA). DESIGN: Post hoc analysis of a multicenter, randomized, controlled trial. SETTING: Fifteen Japanese ICUs. PATIENTS: Cardiogenic OHCA enrolled in the HYBRID II trial. INTERVENTIONS: Hydrogen mixed oxygen (hydrogen group) versus oxygen alone (control group). MEASUREMENTS AND MAIN RESULTS: TTM was performed at a target temperature of 32-34°C (TTM32-TTM34) or 35-36°C (TTM35-TTM36) per the institutional protocol. The association between hydrogen + TTM32-TTM34 and 90-day good neurologic outcomes was analyzed using generalized estimating equations. The 90-day survival was compared between the hydrogen and control groups under TTM32-TTM34 and TTM35-TTM36, respectively. The analysis included 72 patients (hydrogen [ n = 39] and control [ n = 33] groups) with outcome data. TTM32-TTM34 was implemented in 25 (64%) and 24 (73%) patients in the hydrogen and control groups, respectively ( p = 0.46). Under TTM32-TTM34, 17 (68%) and 9 (38%) patients achieved good neurologic outcomes in the hydrogen and control groups, respectively (relative risk: 1.81 [95% CI, 1.05-3.66], p < 0.05). Hydrogen + TTM32-TTM34 was independently associated with good neurologic outcomes (adjusted odds ratio 16.10 [95% CI, 1.88-138.17], p = 0.01). However, hydrogen + TTM32-TTM34 did not improve survival compared with TTM32-TTM34 alone (adjusted hazard ratio: 0.22 [95% CI, 0.05-1.06], p = 0.06). CONCLUSIONS: Hydrogen + TTM32-TTM34 was associated with improved neurologic outcomes after cardiogenic OHCA compared with TTM32-TTM34 monotherapy. Hydrogen inhalation is a promising treatment option for reducing PCABI when combined with TTM32-TTM34.
目的：心脏骤停后护理期间吸入氢气对脑缺血后神经功能转归的疗效（HYBRID）II试验（jRCTs031180352）表明，吸入氢气可能减轻心脏骤停后脑损伤（PCABI）。然而，低温目标温度管理（TTM）与吸入氢气联合应用对转归的影响尚不清楚。本研究旨在探讨吸入氢气与低温TTM联合应用对院外心脏骤停（OHCA）后转归的综合影响。 设计：一项多中心、随机、对照试验的事后分析。 地点：15家日本重症监护病房。 患者：纳入HYBRID II试验的心源性OHCA患者。 干预措施：氢气混合氧气（氢气组）与单纯氧气（对照组）。 测量指标及主要结果：根据机构方案，TTM目标温度设定为32 - 34°C（TTM32 - TTM34）或35 - 36°C（TTM35 - TTM36）。采用广义估计方程分析氢气 + TTM32 - TTM34与90天良好神经功能转归之间的关联。分别比较氢气组和对照组在TTM32 - TTM34及TTM35 - TTM36下的90天生存率。分析纳入72例有转归数据的患者（氢气组[n = 39]和对照组[n = 33]）。氢气组和对照组分别有25例（64%）和24例（73%）患者实施了TTM32 - TTM34（p = 0.46）。在TTM32 - TTM34下，氢气组和对照组分别有17例（68%）和9例（38%）患者获得良好神经功能转归（相对危险度：1.81[95%CI，1.05 - 3.66]，p < 0.05）。氢气 + TTM32 - TTM34与良好神经功能转归独立相关（校正比值比16.10[95%CI，1.88 - 138.17]，p = 0.01）。然而，与单独使用TTM32 - TTM34相比，氢气 + TTM32 - TTM34并未改善生存率（校正风险比：0.22[95%CI，0.05 - 1.06]，p = 0.06）。 结论：与TTM32 - TTM34单药治疗相比，氢气 + TTM32 - TTM34与心源性OHCA后神经功能转归改善相关。吸入氢气与TTM32 - TTM34联合应用时是减轻PCABI的一种有前景的治疗选择。
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