Therapeutic hypothermia after cardiac arrest: A retrospective comparison of surface and endovascular cooling techniques
Therapeutic hypothermia after cardiac arrest: A retrospective comparison of surface and endovascular cooling techniques
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DOI：
10.1016/j.resuscitation.2010.05.001
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发表时间：
2010-09-01
期刊：
影响因子：
6.5
通讯作者：
Tibby, Shane M.
中科院分区：
文献类型：
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作者：
Gillies, Michael A.;Pratt, Rosalie;Tibby, Shane M.
目的：治疗性低温（32-34℃）推荐用于心脏骤停的昏迷幸存者；然而，冷却的最佳技术是未知的。我们的目的是比较使用表面或血管内技术治疗性低温的疗效、并发症和结果。设计：回顾性队列研究。环境：有30个床位的教学医院重症监护室。患者：所有患者（83例）在2.5年的时间内接受心脏骤停后的低温治疗。平均年龄61±16岁；88%的骤停发生在院外，64%为心室颤动/心动过速。干预措施：在ICU使用冷冻哈特曼氏液开始治疗性低温，随后进行表面（n = 41）或血管内（n = 42）冷却；技术的选择是基于血管内装置的可用性。目标温度为32-34摄氏度，持续12-24小时，然后以0.25摄氏度/小时（-1）的速度重新加热。测量结果及主要结果：血管内冷却在目标温度范围内的时间较长（p = 0.02），温度波动较小（p = 0.003），再温时控制较好（0.04），48小时温度负荷较低（p = 0.008）。在过冷（p = 0.05）和未达到目标温度（p = 0.04）方面，血管内冷却也较少产生与冷却相关的并发症。在对已知混杂因素进行调整后，两组在ICU或医院死亡率、无呼吸机天数和神经系统预后方面没有差异。结论：血管内冷却比表面冷却具有更好的温度管理效果，且并发症更少。这项小型研究结果的等效性需要在一项随机试验中得到证实。2010爱思唯尔爱尔兰有限公司版权所有。
Objectives: Therapeutic hypothermia (32-34 degrees C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome.Design: Retrospective cohort study.Setting: Thirty-bed teaching hospital intensive care unit (ICU).Patients: All patients (n = 83) undergoing therapeutic hypothermia following cardiac arrest over a 2.5-year period. The mean age was 61 +/- 16 years; 88% of arrests occurred out of hospital, and 64% were ventricular fibrillation/tachycardia.Interventions: Therapeutic hypothermia was initiated in the ICU using iced Hartmann's solution, followed by either surface (n = 41) or endovascular (n = 42) cooling; choice of technique was based upon endovascular device availability. The target temperature was 32-34 degrees C for 12-24h, followed by rewarming at a rate of 0.25 degrees C h(-1).Measurements and main results: Endovascular cooling provided a longer time within the target temperature range (p = 0.02), less temperature fluctuation (p = 0.003), better control during rewarming (0.04), and a lower 48-h temperature load (p = 0.008). Endovascular cooling also produced less cooling-associated complications in terms of both overcooling (p = 0.05) and failure to reach the target temperature (p = 0.04). After adjustment for known confounders, there were no differences in outcome between the groups in terms of ICU or hospital mortality, ventilator free days and neurological outcome. Conclusion: Endovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial. (C) 2010 Elsevier Ireland Ltd. All rights reserved.