Xia Weiping, Ai Meiling, Ma Xinhua, Hu Chenhuan, Peng Qianyi, Zhao Chunguang, Liu Qi, He Shixiong, Huang Li, Zhang Lina
Department of Intensive Care Medicine, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Medicine (Baltimore). 2024 Dec 20;103(51):e40943. doi: 10.1097/MD.0000000000040943.
Cardiac arrest (CA) is an acute emergency with high mortality and is closely associated with the risk of brain damage or systemic ischemia-reperfusion injury, post-traumatic stress symptoms.
Targeted temperature management in the intensive care unit can improve the neurological outcomes of patients who are comatose after resuscitation from CA. However, there is often a lack of specific evaluation methods for optimal target temperature settings.
From November 2021 to October 2022, 9 CA patients received prompt cardiopulmonary resuscitation and return of spontaneous circulation after approximately 10 to 30 minutes of cardiopulmonary resuscitation in Xiangya Hospital, Central South University.
We retrospectively reviewed 9 CA patients' medical data, including demographic characteristics, hemodynamic change, clinically relevant score, imageological examination, transcranial Doppler ultrasonography, electroencephalogram (EEG), somatosensory-evoked potential, and laboratory data.
According to the result of each patient's transcranial Doppler ultrasonography, somatosensory-evoked potential, and EEG to formulate an individualized target temperature. Contrary to the internationally recommended target of hypothermia, we found that not all patients require hypothermia therapy to maintain normal cerebrovascular autonomic regulation function. And neuron-specific enolase and S100β in patients showed a downward trend after hypothermia therapy. Compared with before hypothermia treatment, clinically relevant scores were reduced in patients with good prognosis. Intracranial congestion or ischemia was improved and intracranial pressure was reduced in all patients during hypothermia treatment. For patients with good EEG response, the ratio of gray matter in the brain increased and the neurological prognosis was significantly improved. Finally, after 6 months of follow-up, we found 3 patients died and 1 patient had a long-term vegetative state, the other patients had a good prognosis.
Individualized targeted temperature management under the guidance of multimodal brain monitoring plays an important role in brain protection of patients with CA.
心脏骤停（CA）是一种死亡率高的急性紧急情况，与脑损伤或全身缺血再灌注损伤、创伤后应激症状的风险密切相关。
重症监护病房中的目标温度管理可改善CA复苏后昏迷患者的神经学预后。然而，对于最佳目标温度设置往往缺乏具体的评估方法。
2021年11月至2022年10月，中南大学湘雅医院9例CA患者在进行约10至30分钟心肺复苏后接受了及时的心肺复苏并恢复自主循环。
我们回顾性分析了9例CA患者的医疗数据，包括人口统计学特征、血流动力学变化、临床相关评分、影像学检查、经颅多普勒超声、脑电图（EEG）、体感诱发电位和实验室数据。
根据每位患者的经颅多普勒超声、体感诱发电位和EEG结果制定个体化目标温度。与国际推荐的低温目标相反，我们发现并非所有患者都需要低温治疗来维持正常的脑血管自主调节功能。低温治疗后患者的神经元特异性烯醇化酶和S100β呈下降趋势。与低温治疗前相比，预后良好的患者临床相关评分降低。低温治疗期间所有患者的颅内充血或缺血情况均得到改善，颅内压降低。对于EEG反应良好的患者，脑灰质比例增加且神经学预后显著改善。最后，经过6个月的随访，我们发现3例患者死亡，1例患者处于长期植物人状态，其他患者预后良好。
在多模态脑监测指导下的个体化目标温度管理对CA患者的脑保护起着重要作用。
