Hara Chiaki, Taira Takuya, Inoue Akihiko, Nishimura Takeshi, Kikuta Shota, Yamamoto Nobuhiro, Ijuin Shinichi, Takauji Shuhei, Hayakawa Mineji, Ishihara Satoshi
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan.
Faculty of Medicine, Graduate School of Medicine, Kagawa University, Kagawa, Japan.
Crit Care Med. 2025 Jul 1;53(7):e1416-e1425. doi: 10.1097/CCM.0000000000006712. Epub 2025 Jun 3.
Accidental hypothermia has high mortality. Rewarming is the initial primary management strategy. However, detailed evidence on rewarming management is limited, that is, rewarming rate is unclear, particularly with noncardiac arrest. Here, we evaluated the association between rewarming rate in the early phase of rewarming and survival and neurologic outcomes in patients with accidental hypothermia.
A secondary analysis of a nationwide, multicenter, prospective, observational study-the Intensive Care with ExtraCorporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study-including adult patients admitted with moderate-to-severe accidental hypothermia between 2019 and 2022.
Emergency medical facilities in Japan ( n = 36).
Patients whose body temperature less than 32°C on arrival at the emergency department.
None.
The early phase of rewarming was defined as the time from arrival at the emergency department to achieving a body temperature of 33°C. Primary and secondary outcomes included 28-day survival after admission and favorable neurologic status at discharge (Cerebral Performance Category score of 1-2). The median rewarming rates in the early phase was 1.35°C/hr (interquartile range, 0.91-2.03°C/hr). Overall, the 28-day survival rate was 82.0% ( n = 324), and the proportion of favorable neurologic outcome was 66.6% ( n = 263). Multivariable logistic regression analysis showed that the rewarming rate was significantly associated with 28-day survival and favorable neurologic outcomes in the early phase (odds ratio [OR], 1.51; 95% CI, 1.10-2.09; p = 0.011 and OR, 1.32; 95% CI, 1.06-1.64; p = 0.015).
In the early phase, the rewarming rate was associated with survival and favorable neurologic outcomes.
意外低温具有高死亡率。复温是初始的主要治疗策略。然而，关于复温管理的详细证据有限，即复温速率尚不清楚，尤其是在非心脏骤停的情况下。在此，我们评估了意外低温患者复温早期的复温速率与生存及神经学转归之间的关联。
对一项全国性、多中心、前瞻性观察性研究——意外严重低温体外膜肺氧合复温重症监护（ICE-CRASH）研究——进行二次分析，纳入2019年至2022年间因中度至重度意外低温入院的成年患者。
日本的急诊医疗设施（n = 36）。
到达急诊科时体温低于32°C的患者。
无。
复温早期定义为从到达急诊科至体温达到33°C的时间段。主要和次要结局包括入院后28天生存率及出院时良好的神经学状态（脑功能分类评分为1 - 2）。复温早期的中位复温速率为1.35°C/小时（四分位间距，0.91 - 2.03°C/小时）。总体而言，28天生存率为82.0%（n = 324），良好神经学转归的比例为66.6%（n = 263）。多变量逻辑回归分析显示，复温速率与早期28天生存率及良好神经学转归显著相关（比值比[OR]，1.51；95%置信区间，1.10 - 2.09；p = 0.011；OR，1.32；95%置信区间，1.06 - 1.64；p = 0.015）。
在复温早期，复温速率与生存及良好神经学转归相关。
