Cochrane corner: hypothermia for neuroprotection in adults after cardiopulmonary resuscitation.
Cochrane corner: hypothermia for neuroprotection in adults after cardiopulmonary resuscitation.
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DOI：
10.1213/ane.0b013e3181ce8d34
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发表时间：
2010-04-01
影响因子：
5.7
通讯作者：
Mullner, Marcus
中科院分区：
文献类型：
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作者：
Arrich, Jasmin;Holzer, Michael;Mullner, Marcus
背景：心脏骤停后良好的神经系统预后很难实现。在复苏阶段的干预和事件发生后最初几个小时内的治疗是至关重要的。实验证据表明，治疗性低温是有益的，关于这一主题的一些临床研究已经发表。目的：我们进行了一项系统回顾和荟萃分析，以评估心脏骤停后治疗性低温治疗的有效性。神经系统转归、生存和不良事件是我们的主要转归参数。我们的目的是在数据可用的情况下进行个体患者数据分析，并根据心脏骤停情况从亚组中进行分析。检索策略：我们检索了以下数据库：Cochrane中央对照试验注册库（the Cochrane Library， 2007年第1期）；MEDLINE（1971年至2007年1月）；EMBASE（1987 - 2007年1月）；1988年至2007年1月；PASCAL（2000 - 2007年1月）；和BIOSIS（1989年至2007年1月）。选择标准：我们纳入了所有随机对照试验，评估无语言限制的心脏骤停患者治疗性低温的有效性。研究仅限于在心脏骤停6小时内用任何冷却方法冷却的成年人群。数据收集和分析：将有效性测量、干预措施、结果参数和其他基线变量输入数据库。荟萃分析仅针对可比较研究的一个子集，异质性可忽略不计。对于这些研究，个体患者数据是可用的。主要结果：系统评价纳入了481例患者的4项试验和1份摘要报告。5项纳入研究中有3项质量良好。对于传统冷却方法的三个可比研究，所有作者都提供了个体患者数据。与标准的复苏后护理相比，采用常规冷却方法的低温组患者在住院期间更有可能达到1或2的最佳脑功能类别评分（CPC，五分制；1=脑功能良好，5=脑死亡）（个体患者数据；RR, 1.55; 95% CI 1.22至1.96），并且更有可能存活至出院（个体患者数据；RR, 1.35; 95% CI 1.10至1.65）。在所有的研究中，低温和对照组之间报告的不良事件没有显著差异。作者的结论：传统的冷却方法诱导轻度治疗性低温似乎可以改善心脏骤停后的生存率和神经系统预后。我们的综述支持国际复苏指南所推荐的当前最佳医疗实践。
BACKGROUND: Good neurologic outcome after cardiac arrest is hard to achieve. Interventions during the resuscitation phase and treatment within the first hours after the event are critical. Experimental evidence suggests that therapeutic hypothermia is beneficial, and a number of clinical studies on this subject have been published.OBJECTIVES: We performed a systematic review and meta-analysis to assess the effectiveness of therapeutic hypothermia in patients after cardiac arrest. Neurologic outcome, survival and adverse events were our main outcome parameters. We aimed to perform individual patient data analysis if data were available, and to from subgroups according to the cardiac arrest situation.SEARCH STRATEGY: We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007 Issue 1); MEDLINE (1971 to January 2007); EMBASE (1987 to January 2007); CINAHL (1988 to January 2007); PASCAL (2000 to January 2007); and BIOSIS (1989 to January 2007).SELECTION CRITERIA: We included all randomized controlled trials assessing the effectiveness of the therapeutic hypothermia in patients after cardiac arrest without language restrictions. Studies were restricted to adult populations cooled with any cooling method applied within six hours of cardiac arrest.DATA COLLECTION AND ANALYSIS: Validity measures, the intervention, outcome parameters and additional baseline variables were entered into the database. Meta-analysis was only done for a subset of comparable studies with negligible heterogeneity. For these studies individual patient data were available.MAIN RESULTS: Four trials and one abstract reporting on 481 patients were included in the systematic review. Quality of the included studies was good in three out of five included studies. For the three comparable studies on conventional cooling methods all authors provided individual patient data. With conventional cooling methods patients in the hypothermia group were more likely to reach a best cerebral performance categories score of one or two (CPC, five point scale; 1=good cerebral performance, to 5=brain death) during hospital stay (individual patient data; RR, 1.55; 95% CI 1.22 to 1.96) and were more likely to survive to hospital discharge (individual patient data; RR, 1.35; 95% CI 1.10 to 1.65) compared to standard post-resuscitation care. Across all studies there was no significant difference in reported adverse events between hypothermia and control.AUTHORS' CONCLUSIONS: Conventional cooling methods to induce mild therapeutic hypothermia seem to improve survival and neurologic outcome after cardiac arrest. Our review supports the current best medical practice as recommended by the International Resuscitation Guidelines.