Bang Hyo Jin, Youn Chun Song, Lee Byung Kook, Oh Sang Hoon, Kim Hyo Joon, Gong Ae Kyung, Lee Ji-Sook, Kim Soo Hyun, Park Kyu Nam, Cho In Soo
Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Emergency Medicine, Chonnam National University Hospital, Chonnam National University of Medical School, 42, Jebong-ro, Donggu, Gwangju 61469, Republic of Korea.
J Clin Med. 2025 Aug 21;14(16):5898. doi: 10.3390/jcm14165898.
Most out-of-hospital cardiac arrest (OHCA) survivors are comatose due to hypoxic ischemic brain injury. Targeted temperature management (TTM) is the only evidence-based neuroprotective intervention for this condition; however, the optimal implementation of TTM has yet to be determined. The concept of high-quality TTM has been proposed to improve patient outcomes, but its clinical impact has not been thoroughly evaluated. This study investigates whether adherence to high-quality TTM is associated with improved neurological outcomes and survival among OHCA patients. : This retrospective analysis used data from the Korean Hypothermia Network Prospective Registry 1.0, including 1060 adult OHCA patients treated with TTM at 33 °C between 2015 and 2018. High-quality TTM was defined as follows: temperature variability during maintenance within ±1.0 °C, maintenance duration ≥ 24 h, rewarming rate ≤ 0.5 °C/h, and post-TTM fever control (temperature < 38.5 °C). Patients were classified into high- and low-quality TTM groups. The primary outcomes were survival and neurological status (CPC ranging from 1 to 2 indicated a good outcome) 6 months after cardiac arrest (CA). : Of the 1060 patients, 491 (46.3%) received high-quality TTM. Compared with the low-quality TTM group, the high-quality TTM group had higher rates of survival (44.6% vs. 36.4%, = 0.006). Multivariate analysis revealed that high-quality TTM was independently associated with survival (OR 1.802, 95% CI: 1.171-2.773) and good neurological outcomes (OR 1.748, 95% CI: 1.102-2.770). : High-quality TTM is associated with improved survival and better neurological outcomes in OHCA patients. Standardizing TTM delivery on the basis of quality metrics may increase its effectiveness in clinical practice.
大多数院外心脏骤停（OHCA）幸存者因缺氧缺血性脑损伤而昏迷。目标温度管理（TTM）是针对这种情况的唯一基于证据的神经保护干预措施；然而，TTM的最佳实施方式尚未确定。为改善患者预后，已提出高质量TTM的概念，但其临床影响尚未得到充分评估。本研究调查了OHCA患者坚持高质量TTM是否与改善神经功能预后和生存率相关。：这项回顾性分析使用了韩国低温网络前瞻性注册研究1.0的数据，包括2015年至2018年期间接受33℃TTM治疗的1060例成年OHCA患者。高质量TTM的定义如下：维持期间温度变化在±1.0℃以内，维持时间≥24小时，复温速率≤0.5℃/小时，以及TTM后发热控制（体温<38.5℃）。患者被分为高质量和低质量TTM组。主要结局是心脏骤停（CA）后6个月的生存率和神经功能状态（脑功能分级[CPC]为1至2表示预后良好）。：在1060例患者中，491例（46.3%）接受了高质量TTM。与低质量TTM组相比，高质量TTM组的生存率更高（44.6%对36.4%，P = 0.006）。多因素分析显示，高质量TTM与生存率（比值比[OR]为1.802，95%置信区间[CI]：1.171 - 2.773）和良好的神经功能预后（OR为1.748，95% CI：1.102 - 2.770）独立相关。：高质量TTM与OHCA患者生存率提高和神经功能预后改善相关。根据质量指标规范TTM的实施可能会提高其在临床实践中的有效性。
