Mendrala Konrad, Darocha Tomasz, Brožek Tomáš, Kosiński Sylweriusz, Balik Martin, Cools Evelien, Walpoth Beat, Nowak Ewelina, Dąbrowski Wojciech, Miazgowski Bartosz, Reszka Kacper, Rutkiewicz Aleksander, Debaty Guillaume, Segond Nicolas, Dudek Michał, Górski Stanisław, Podsiadło Paweł
Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland.
Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Intern Emerg Med. 2025 Jun;20(4):1177-1184. doi: 10.1007/s11739-024-03741-1. Epub 2024 Sep 12.
Hemodynamically unstable patients with severe hypothermia and preserved circulation should be transported to dedicated extracorporeal life support (ECLS) centers, but not all are eligible for extracorporeal therapy. In this group of patients, the outcome of rewarming may sometimes be unfavorable. It is, therefore, crucial to identify potential risk factors for death. Furthermore, it is unclear what criterion for hemodynamic stability should be adopted for patients with severe hypothermia. The aim of this study is to identify pre-rewarming predictors of death and their threshold values in hypothermic patients with core temperature ≤ 28 °C and preserved circulation, who were treated without extracorporeal rewarming. We conducted a multicenter retrospective study involving patients in accidental hypothermia with core temperature 28 °C or lower, and preserved spontaneous circulation on rewarming initiation. The data were collected from the International Hypothermia Registry, HELP Registry, and additional hospital data. The primary outcome was survival to hospital discharge. We conducted a multivariable logistic regression and receiver operating characteristic curve (ROC) analysis. In the multivariate analysis of laboratory tests and vital signs, systolic blood pressure (SBP) adjusted for cooling circumstances and base excess (BE) were identified as the best predictor of death (OR 0.974 95% CI 0.952-0.996), AUC ROC 0.79 (0.70-0.88). The clinically relevant cutoff for SBP was identified at 90 mmHg with a sensitivity of 0.74 (0.54-0.89) and a specificity of 0.70 (0.60-0.79). The increased risk of death among hypothermic patients with preserved circulation occurs among those with an SBP below 90 mmHg and in those who developed hypothermia in their homes.
血流动力学不稳定的严重低温且循环尚存的患者应被转运至专门的体外生命支持（ECLS）中心，但并非所有患者都适合接受体外治疗。在这组患者中，复温的结果有时可能并不理想。因此，识别潜在的死亡风险因素至关重要。此外，对于严重低温患者应采用何种血流动力学稳定性标准尚不清楚。本研究的目的是确定体温≤28°C且循环尚存、未接受体外复温治疗的低温患者复温前的死亡预测因素及其阈值。我们进行了一项多中心回顾性研究，纳入体温28°C或更低的意外低温患者，且复温开始时自发循环尚存。数据收集自国际低温注册中心、HELP注册中心及其他医院数据。主要结局是存活至出院。我们进行了多变量逻辑回归和受试者工作特征曲线（ROC）分析。在实验室检查和生命体征的多变量分析中，经降温情况和碱剩余（BE）校正的收缩压（SBP）被确定为死亡的最佳预测因素（OR 0.974，95%CI 0.952 - 0.996），AUC ROC为0.79（0.70 - 0.88）。SBP的临床相关临界值确定为90 mmHg，敏感性为0.74（0.54 - 0.89），特异性为0.70（0.60 - 0.79）。循环尚存的低温患者中，SBP低于90 mmHg以及在家中发生低温的患者死亡风险增加。
