镇静深度对心脏骤停后患者神经学转归的影响——一项回顾性队列研究
Impact of sedation depth on neurological outcome in post-cardiac arrest patients - A retrospective cohort study.
作者信息
Staudacher Dawid Leander, Heine Laura, Rilinger Jonathan, Maier Alexander, Rottmann Felix A, Zotzmann Viviane, Kaier Klaus, Biever Paul Marc, Supady Alexander, Westermann Dirk, Wengenmayer Tobias, Jäckel Markus
机构信息
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, Germany.
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, Germany; Department of Diagnostic and Interventional Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany.
出版信息
Resuscitation. 2024 Dec;205:110456. doi: 10.1016/j.resuscitation.2024.110456. Epub 2024 Dec 2.
AIMS
Whether targeted temperature management (TTM) might improve neurologic prognosis in patients after cardiac arrest is currently under debate. Data concerning sedation depth during TTM is rare. This study aimed to compare the impact of different sedation depths on neurological outcomes in post-cardiac arrest patients undergoing TTM.
METHODS
In this retrospective, before-and-after registry study, all patients receiving TTM on a medical ICU between 08/2016 and 03/2021 were included. This study evaluated the following sedation targets: RASS-target during TTM -5 until 08/2019 and RASS-target -4 since 09/2019. The primary endpoint was favorable neurological outcome at ICU discharge, defined as a Cerebral Performance Category (CPC) score of 1 or 2.
RESULTS
403 patients were included (RASS-target -5: N = 285; RASS-target -4: N = 118). Favorable neurological outcome was documented in 54/118 (45.8 %) patients in the group with a RASS-target of -4 compared to 111/285 (38.9 %) in the group with a RASS-target of -5. After adjustment for age, sex, initial shockable rhythm, bystander CPR, duration of CPR and mean arterial pressure 12 h after CPR, favorable neurological outcome was associated with RASS-target -4 (OR 1.82 (95 % CI: 1.02-3.23); p = 0.042). ICU survival was similar in both groups while 30-day survival was associated with RASS-target -4 (OR 1.81 (1.01-3.26); p = 0.047).
CONCLUSION
Lighter sedation strategies during TTM after cardiac arrest might improve outcome and should be further investigated.
目的
目标温度管理（TTM）能否改善心脏骤停后患者的神经学预后目前仍存在争议。关于TTM期间镇静深度的数据很少。本研究旨在比较不同镇静深度对接受TTM的心脏骤停后患者神经学结局的影响。
方法
在这项回顾性前后对照注册研究中，纳入了2016年8月至2021年3月期间在医疗重症监护病房接受TTM的所有患者。本研究评估了以下镇静目标：2019年8月之前TTM期间的RASS目标为-5，自2019年9月起RASS目标为-4。主要终点是重症监护病房出院时良好的神经学结局，定义为脑功能分类（CPC）评分为1或2。
结果
纳入403例患者（RASS目标为-5：N = 285；RASS目标为-4：N = 118）。RASS目标为-4的组中有54/118例（45.8%）患者记录到良好的神经学结局，而RASS目标为-5的组中为111/285例（38.9%）。在调整年龄、性别、初始可电击心律、旁观者心肺复苏、心肺复苏持续时间和心肺复苏后12小时平均动脉压后，良好的神经学结局与RASS目标为-4相关（OR 1.82（95% CI：1.02 - 3.23）；p = 0.042）。两组的重症监护病房生存率相似，而30天生存率与RASS目标为-4相关（OR 1.81（1.01 - 3.26）；p = 0.047）。
结论
心脏骤停后TTM期间较轻的镇静策略可能改善结局，应进一步研究。
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