From the Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern (JK, RS, MH), Swiss Air-Rescue (Rega), Zurich, Switzerland (JK), the Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen (SH, SR, MF), the Emergency Department, University Hospital, Heinrich-Heine University, Düsseldorf, Germany (MB).
Eur J Anaesthesiol. 2024 Oct 1;41(10):779-786. doi: 10.1097/EJA.0000000000002016. Epub 2024 May 27.
For nearly 20 years, in international guidelines, mild therapeutic hypothermia (MTH) was an important component of postresuscitation care. However, recent randomised controlled trials have questioned its benefits. At present, international guidelines only recommend actively preventing fever, but there are ongoing discussions about whether the majority of cardiac arrest patients could benefit from MTH treatment.
The aim of this study was to compare the outcome of adult patients treated with and without MTH after cardiac arrest.
Observational cohort study.
German Resuscitation Registry covering more than 31 million inhabitants of Germany and Austria.
All adult patients between 2006 and 2022 with out-of-hospital or in-hospital cardiac arrest and comatose on admission.
Primary endpoint: hospital discharge with good neurological outcome [cerebral performance categories (CPC) 1 or 2]. Secondary endpoint: hospital discharge. We used a multivariate binary logistic regression analysis to identify the effects on outcome of all known influencing variables.
We analysed 33 933 patients (10 034 treated with MTH, 23 899 without MTH). The multivariate regression model revealed that MTH was an independent predictor of CPC 1/2 survival and of hospital discharge with odds ratio (95% confidence intervals) of 1.60 (1.49 to 1.72), P < 0.001 and 1.89 (1.76 to 2.02), P < 0.001, respectively.
Our data indicate the existence of a positive association between MTH and a favourable neurological outcome after cardiac arrest. It therefore seems premature to refrain from giving MTH treatment for the entire spectrum of patients after cardiac arrest. Further prospective studies are needed.
近 20 年来，在国际指南中，轻度治疗性低体温（MTH）是复苏后治疗的重要组成部分。然而，最近的随机对照试验对其益处提出了质疑。目前，国际指南仅建议积极预防发热，但关于大多数心脏骤停患者是否可以从 MTH 治疗中获益，仍存在争议。
本研究旨在比较心脏骤停后接受和未接受 MTH 治疗的成年患者的结局。
观察性队列研究。
覆盖德国和奥地利超过 3100 万居民的德国复苏登记处。
2006 年至 2022 年间所有患有院外或院内心脏骤停且入院时昏迷的成年患者。
主要终点：医院出院时具有良好神经功能结局[脑功能分类（CPC）1 或 2]。次要终点：医院出院。我们使用多变量二项逻辑回归分析来确定所有已知影响变量对结局的影响。
我们分析了 33933 例患者（10034 例接受 MTH 治疗，23899 例未接受 MTH 治疗）。多变量回归模型显示，MTH 是 CPC 1/2 生存率和医院出院的独立预测因素，优势比（95%置信区间）分别为 1.60（1.49 至 1.72），P<0.001 和 1.89（1.76 至 2.02），P<0.001。
我们的数据表明，MTH 与心脏骤停后良好的神经功能结局之间存在正相关。因此，对于心脏骤停后所有患者，暂不给予 MTH 治疗似乎为时过早。需要进一步的前瞻性研究。
