Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest
Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest
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DOI：
10.1056/nejmoa1310519
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发表时间：
2013-12-05
影响因子：
158.5
通讯作者：
Friberg, Hans
中科院分区：
文献类型：
--
作者：
Nielsen, Niklas;Wettersley, Jorn;Friberg, Hans
背景：院外心脏骤停的无意识幸存者有很高的死亡风险或神经功能不良。国际指南推荐治疗性低温，但支持证据有限，与最佳结局相关的目标温度未知。我们的目标是比较两个目标温度，都是为了防止fever.MethodsIn一项国际试验中，我们随机分配950名无意识的成年人后，院外心脏骤停的推定心脏原因有针对性的温度管理在33摄氏度或36摄氏度。主要结局是试验结束时的全因死亡率。次要结果包括一个复合不良的神经功能或死亡在180天，与脑功能分类（CPC）规模和修改后的兰金scale.ResultsIn总，939例患者被纳入主要分析。在试验结束时，33摄氏度组中有50%的患者（473例患者中的235例）死亡，而36 ℃组中的患者死亡率为48%（466例患者中的225例）（33 ℃的风险比为1.06; 95%置信区间[CI]为0.89至1.28; P=0.51）。在180天随访时，33 ℃组中54%的患者死亡或根据CPC神经功能不良，而36 ℃组中52%的患者死亡或神经功能不良（风险比，1.02; 95%CI，0.88至1.16; P=0.78）。在使用改良兰金量表的分析中，两组的可比率为52%（风险比，1.01; 95%CI，0.89 - 1.14; P=0.87）。调整已知的预后因素的分析结果是similar.ConclusionsIn无意识的幸存者的院外心脏骤停的推定心脏原因，低温在33摄氏度的目标温度并没有带来好处相比，目标温度为36摄氏度。（由瑞典心肺基金会和其他机构资助; TTM ClinicalTrials.gov编号，NCT 01020916。）
BackgroundUnconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever.MethodsIn an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33 degrees C or 36 degrees C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale.ResultsIn total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33 degrees C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36 degrees C group (225 of 466 patients) (hazard ratio with a temperature of 33 degrees C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33 degrees C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36 degrees C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar.ConclusionsIn unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33 degrees C did not confer a benefit as compared with a targeted temperature of 36 degrees C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.)