Bitzer Kasper, Breindahl Niklas, Kelly Benjamin, Sørensen Oliver Beierholm, Laugesen Monika, Wolthers Signe Amalie, Blomberg Stig Nikolaj Fasmer, Steinmetz Jacob, Wiberg Sebastian, Christensen Helle Collatz
Prehospital Center Region Zealand, Ringstedgade 61, 13th floor, 4700 Naestved, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Prehospital Center Region Zealand, Ringstedgade 61, 13th floor, 4700 Naestved, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Resuscitation. 2025 Feb;207:110486. doi: 10.1016/j.resuscitation.2024.110486. Epub 2025 Jan 10.
This study aimed to investigate the associations between hypothermia and mortality or poor neurological outcome in a nationwide cohort of drowning patients with out-of-hospital cardiac arrest (OHCA).
This nationwide, registry-based cohort study reported in-hospital data on drowning patients with OHCA following the Utstein Style For Drowning. Drowning patients with OHCA were identified in the Danish Cardiac Arrest Registry from 2016 to 2021. The primary outcome was the rate of mortality or poor neurological outcome (corresponding to a modified Rankin Scale [mRS] score > 3) at 180 days after the drowning incident in patients with OHCA and accidental hypothermia (<35 °C) vs normothermia (≥35 °C).
This study identified 118 drowning patients with OHCA and found an increased rate of mRS > 3 at 180 days after the drowning incident in the hypothermic group compared to the normothermic group (74% vs 18%, p < 0.001). The 180-day mortality (mRS = 6) was 69% in the hypothermic group compared to 16% in the normothermic group (p < 0.001). The hypothermic group had higher rates of ongoing CPR at hospital admission (45% vs 7%, p < 0.001), intensive care unit admission (70% vs 41%, p = 0.003), and mechanical ventilation during hospitalisation (78% vs 32%, p < 0.001) compared to the normothermic group.
Hypothermic drowning patients with OHCA had a higher risk of mortality or poor neurological outcome at 180 days compared to normothermic drowning patients with OHCA. This association may likely be explained by confounding factors such as prolonged submersion and cardiac arrest. Further research is warranted.
本研究旨在调查在全国范围内院外心脏骤停（OHCA）溺水患者队列中，体温过低与死亡率或不良神经学预后之间的关联。
这项基于登记处的全国性队列研究报告了按照溺水Utstein模式的OHCA溺水患者的院内数据。2016年至2021年期间在丹麦心脏骤停登记处识别出OHCA溺水患者。主要结局是OHCA且意外体温过低（<35°C）与体温正常（≥35°C）的患者在溺水事件发生180天后的死亡率或不良神经学预后发生率（对应改良Rankin量表[mRS]评分>3）。
本研究识别出118例OHCA溺水患者，发现体温过低组在溺水事件发生180天后mRS>3的发生率高于体温正常组（74%对18%，p<0.001）。体温过低组180天死亡率（mRS=6）为69%，而体温正常组为16%（p<0.001）。与体温正常组相比，体温过低组入院时正在进行心肺复苏的比例更高（45%对7%，p<0.001）、入住重症监护病房的比例更高（70%对41%，p=0.003）以及住院期间机械通气的比例更高（78%对32%，p<0.001）。
与体温正常的OHCA溺水患者相比，体温过低的OHCA溺水患者在180天时死亡或出现不良神经学预后的风险更高。这种关联可能由诸如长时间溺水和心脏骤停等混杂因素所解释。有必要进行进一步研究。
