CHRU Nancy, Service de Réanimation Médicale Brabois, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France.
CHRU Nancy, Service de Réanimation Médicale Brabois, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France; INSERM U1116, Faculté de Médecine, Université de Lorraine, Vandoeuvre-les-Nancy, Nancy, France.
J Crit Care. 2024 Dec;84:154903. doi: 10.1016/j.jcrc.2024.154903. Epub 2024 Aug 30.
Recent guidelines for post-cardiac arrest (CA) management have undergone significant changes regarding targeted therapeutic management (TTM), transitioning from hypothermia to temperature control. We aimed to assess changes in post-CA management in French intensive care units following the new recommendations.
Two declarative web surveys were conducted from March to August 2023. We compared the doctors' survey to that previously published in 2015. We contacted 389 departments from 276 French centers.
Three hundred thirty-four physicians from 189 distinct ICUs departments participated in the survey. TTM was used by 95.5 % of respondents. TTM with temperature feedback device was used by 64 % of respondents. In multivariate analysis, use of TTM with temperature feedback was associated with university hospital responder [OR 1.99 (1.19-3.34, p = 0.009)], high CA admissions rate [OR 2.25 (1.13-4.78, p = 0.026)], use of a written CA procedure [OR 1.76 (1.07-2.92, p = 0.027)] and presence of a cath-lab performing coronary angiography [OR 2.42 (1.33-4.44, p = 0.004)]. The targeted temperature rose from 32 to 34 °C in 2015, to 35-36 °C in 2023 (p < 0.001). Proportions of TTM with temperature feedback devices switched from 45 % to 65 % (p < 0.001). 660 nurses responses from 150 ICUs were analyzed. According to TTM users, gel-coated water circulating pads and intravascular cooling were considered the most effective devices and were found to be easily adjustable.
These surveys provide insights into post-resuscitation care and TTM practice in France. One year after their publication, the latest recommendations concerning TTM have not been fully implemented, as the majority of ICUs continue to use moderate hypothermia. They widely reported employing specific TTM, with the use of TTM with temperature feedback devices increasing significantly. Heterogeneity exists regarding the TTM systems used, with a significant proportion lacking temperature feedback. This aspect requires specific attention, depending on local constraints and devices costs.
最近关于心脏骤停后（CA）管理的指南在靶向治疗管理（TTM）方面发生了重大变化，从低温治疗转向体温控制。我们旨在评估新建议发布后法国重症监护病房 CA 后管理的变化。
2023 年 3 月至 8 月进行了两次陈述性网络调查。我们将医生调查与 2015 年发表的调查进行了比较。我们联系了来自 276 个法国中心的 389 个部门。
来自 189 个不同 ICU 部门的 334 名医生参与了调查。95.5%的受访者使用了 TTM。64%的受访者使用了带温度反馈装置的 TTM。多变量分析显示，使用带温度反馈的 TTM 与大学医院响应者相关[比值比 1.99（1.19-3.34，p=0.009）]、高 CA 入院率[比值比 2.25（1.13-4.78，p=0.026）]、使用书面 CA 程序[比值比 1.76（1.07-2.92，p=0.027）]和存在进行冠状动脉造影的导管实验室[比值比 2.42（1.33-4.44，p=0.004）]。目标温度从 2015 年的 32°C 上升到 2023 年的 35-36°C（p<0.001）。带温度反馈装置的 TTM 比例从 45%上升到 65%（p<0.001）。分析了来自 150 个 ICU 的 660 名护士的回答。根据 TTM 用户的说法，涂有凝胶的水循环垫和血管内冷却被认为是最有效的设备，并且发现它们易于调节。
这些调查提供了法国复苏后护理和 TTM 实践的见解。新建议发布一年后，大多数 ICU 仍在使用中度低温治疗，因此尚未完全实施 TTM 的最新建议。他们广泛报告使用特定的 TTM，使用带温度反馈装置的 TTM 的使用显著增加。使用的 TTM 系统存在差异，很大一部分缺乏温度反馈。这方面需要根据当地限制和设备成本给予特别关注。
