Mild therapeutic hypothermia improves outcomes compared with normothermia in cardiac-arrest patients-a retrospective chart review

被引：24

作者：

Hoerburger, David ^{[1
]}

Testori, Christoph ^{[1
]}

Sterz, Fritz ^{[1
]}

Herkner, Harald ^{[1
]}

Krizanac, Danica ^{[1
]}

Uray, Thomas ^{[1
]}

Schober, Andreas ^{[1
]}

Stoeckl, Mathias ^{[1
]}

Stratil, Peter ^{[1
]}

Weiser, Christoph ^{[1
]}

Wallmueller, Christian ^{[1
]}

Holzer, Michael ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Emergency Med, Vienna, Austria

来源：

CRITICAL CARE MEDICINE | 2012年 / 40卷 / 08期

关键词：

cardiopulmonary resuscitation; heart arrest; hypothermia; morbidity; mortality; survival; EUROPEAN-RESUSCITATION-COUNCIL; AMERICAN-HEART-ASSOCIATION; CARDIOPULMONARY-RESUSCITATION; COMATOSE SURVIVORS; STROKE-FOUNDATION; TASK-FORCE; HYPERTHERMIA; GUIDELINES; PROFESSIONALS; STATEMENT;

D O I：

10.1097/CCM.0b013e31825333cf

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: Studies showing the effectiveness of therapeutic hypothermia (32-34 degrees C) in postcardiac arrest patients have been criticized because of patients with elevated body temperature (>37.5 degrees C) in the noncooled control group. Thus, the effects of spontaneous normothermia (<37.5 degrees C) compared with mild therapeutic hypothermia were studied. Design: Retrospective chart review from 1991 to 2010. Patients: Witnessed out-of-hospital arrest, presumed to be of cardiac origin, aged 18 to 80 yrs and with a Glassgow Coma Scale score of <8 at admission. Interventions: Patients with sustained restoration of spontaneous circulation who did not receive therapeutic hypothermia and never exceeded 37.5 degrees C during the 36 hrs postcardiac arrest were compared with patients who received mild therapeutic hypothermia. Measurements and Main Results: The primary end point was a favorable neurological outcome, defined as Cerebral Performance Categories 1 or 2; the secondary end point was overall survival to 180 days. Significantly more patients in the hypothermia group had Cerebral Performance Categories 1 or 2 (hypothermia: 256 of 467 [55%] vs. normothermia: 69 of 165 [42%]) and survived for >180 days (hypothermia: 315 of 467 [67%] vs. normothermia: 79 of 165 [48%]). The propensity score adjusted risk ratio for good neurological outcome of patients undergoing hypothermia treatment was 1.37 (confidence interval 1.09-1.72, p <= .01) and for dying within 180 days was 0.57 (confidence interval 0.44-0.73, p <= .01) compared to normothermia. Conclusions: Therapeutic hypothermia is associated with significantly improved neurological outcome and 180-day survival compared to spontaneous normothermia in cardiac-arrest patients. (Crit Care Med 2012; 40: 2315-2319)

引用

页码：2315 / 2319

页数：5