The effect of mild therapeutic hypothermia on good neurological recovery after out-of-hospital cardiac arrest according to location of return of spontaneous circulation: A nationwide observational study

被引：14

作者：

Bae, Kwang Soo ^{[1
]}

Shin, Sang Do ^{[1
]}

Ro, Young Sun ^{[2
]}

Song, Kyoung Jun ^{[1
]}

Lee, Eui Jung ^{[1
]}

Lee, Yu Jin ^{[1
]}

Suh, Gil Joon ^{[1
]}

Kwak, Young Ho ^{[1
]}

机构：

[1] Seoul Natl Univ, Coll Med, Dept Emergency Med, 101 Daehak Ro, Seoul 110744, South Korea

[2] Seoul Natl Univ Hosp, Biomed Res Inst, Lab Emergency Med Serv, Seoul, South Korea

来源：

RESUSCITATION | 2015年 / 89卷

关键词：

Cardiac arrest; Hypothermia; Return of spontaneous circulation; Outcomes; COMATOSE SURVIVORS; RESUSCITATION; CARE;

D O I：

10.1016/j.resuscitation.2015.01.024

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Mild therapeutic hypothermia (MTH) has been known to be associated with good neurological recovery after out-of-hospital cardiac arrest (OHCA). Prehospital return of spontaneous circulation (P-ROSC) is associated with better hospital outcomes than ROSC at emergency department (ED-ROSC). The study aims to examine the association between MTH by location of ROSC and good neurological recovery after OHCA. Methods: Adult OHCA cases with presumed cardiac etiology who survived to hospital admission were collected from a nationwide cardiac registry between 2008 and 2013. MTH was defined as a case receiving hypothermia procedure regardless of procedure method. Primary outcome was good neurological recovery with cerebral performance category score of 1 and 2. Multivariable logistic regression analysis was performed adjusting for potential confounders with an interaction term between MTH and location of ROSC to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results: Among 11,158 patients survived to admission, good neurological recovery was 23.6% (399/1691) in MTH vs. 15.0% (1400/9316) in non-MTH (p < 0.001), and 58.2% (1074/1864) in P-ROSC vs. 7.9% (725/9161) in ED-ROSC (p < 0.001). There was a significant association between MTH and good neurological recovery (AOR = 1.32, 95% CI = 1.11-1.57). In the interaction model, AOR of MTH and interaction effect with P-ROSC and ED-ROSC was 0.78 (0.58-2.70) and 1.68 (1.34-1.98), respectively. Conclusion: MTH was significantly associated with good neurological recovery among OHCA survivors. In the interaction model, MTH showed significant benefits in patient group with ROSC at ED, not in P-ROSC group. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

引用

页码：129 / 136

页数：8

共 32 条

[1] Intra-arrest cooling improves outcomes in a murine cardiac arrest model [J].

Abella, BS ;

Zhao, DH ;

Alvarado, J ;

Hamann, K ;

Vanden Hoek, TL ;

Becker, LB .

CIRCULATION, 2004, 109 (22) :2786-2791

[2] Epidemiology and outcomes from non-traumatic out-of-hospital cardiac arrest in Korea: A nationwide observational study [J].

Ahn, Ki Ok ;

Shin, Sang Do ;

Suh, Gil Joon ;

Cha, Won Chul ;

Song, Kyoung Jun ;

Kim, Soo Jin ;

Lee, Eui Jung ;

Ong, Marcus Eng Hock .

RESUSCITATION, 2010, 81 (08) :974-981

[3]

[Anonymous], 1991, N Engl J Med, V324, P1225, DOI DOI 10.1056/NEJM199105023241801

[4] Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation [J].

Arrich, Jasmin ;

Holzer, Michael ;

Herkner, Harald ;

Muellner, Marcus .

COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2009, (04)

[5] Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies [J].

Berdowski, Jocelyn ;

Berg, Robert A. ;

Tijssen, Jan G. P. ;

Koster, Rudolph W. .

RESUSCITATION, 2010, 81 (11) :1479-1487

[6] Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest [J].

Bernard, SA ;

Jones, BM ;

Horne, MK .

ANNALS OF EMERGENCY MEDICINE, 1997, 30 (02) :146-153

[7] Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia [J].

Bernard, SA ;

Gray, TW ;

Buist, MD ;

Jones, BM ;

Silvester, W ;

Gutteridge, G ;

Smith, K .

NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (08) :557-563

[8] EFFECT OF MILD HYPOTHERMIA ON ISCHEMIA-INDUCED RELEASE OF NEUROTRANSMITTERS AND FREE FATTY-ACIDS IN RAT-BRAIN [J].

BUSTO, R ;

GLOBUS, MY ;

DIETRICH, WD ;

MARTINEZ, E ;

VALDES, I ;

GINSBERG, MD .

STROKE, 1989, 20 (07) :904-910

[9] Cardiopulmonary resuscitation outcome of out-of-hospital cardiac arrest in low-volume versus high-volume emergency departments: An observational study and propensity score matching analysis [J].

Do Shin, Sang ;

Suh, Gil Joon ;

Ahn, Ki Ok ;

Song, Kyoung Jun .

RESUSCITATION, 2011, 82 (01) :32-39

[10] Heart Disease and Stroke Statistics-2013 Update A Report From the American Heart Association [J].

Go, Alan S. ;

Mozaffarian, Dariush ;

Roger, Veronique L. ;

Benjamin, Emelia J. ;

Berry, Jarett D. ;

Borden, William B. ;

Bravata, Dawn M. ;

Dai, Shifan ;

Ford, Earl S. ;

Fox, Caroline S. ;

Franco, Sheila ;

Fullerton, Heather J. ;

Gillespie, Cathleen ;

Hailpern, Susan M. ;

Heit, John A. ;

Howard, Virginia J. ;

Huffman, Mark D. ;

Kissela, Brett M. ;

Kittner, Steven J. ;

Lackland, Daniel T. ;

Lichtman, Judith H. ;

Lisabeth, Lynda D. ;

Magid, David ;

Marcus, Gregory M. ;

Marelli, Ariane ;

Matchar, David B. ;

McGuire, Darren K. ;

Mohler, Emile R. ;

Moy, Claudia S. ;

Mussolino, Michael E. ;

Nichol, Graham ;

Paynter, Nina P. ;

Schreiner, Pamela J. ;

Sorlie, Paul D. ;

Stein, Joel ;

Turan, Tanya N. ;

Virani, Salim S. ;

Wong, Nathan D. ;

Woo, Daniel ;

Turner, Melanie B. .

CIRCULATION, 2013, 127 (01) :E6-E245

← 1 2 3 4 →