EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest.
EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest.
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DOI：
10.1097/ta.0000000000001945
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发表时间：
2018-07
期刊：
影响因子：
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通讯作者：
Stein DM
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文献类型：
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作者：
Hsu CH;Haac BE;Drake M;Bernard AC;Aiolfi A;Inaba K;Hinson HE;Agarwal C;Galante J;Tibbits EM;Johnson NJ;Carlbom D;Mirhoseini MF;Patel MB;OʼBosky KR;Chan C;Udekwu PO;Farrell M;Wild JL;Young KA;Cullinane DC;Gojmerac DJ;Weissman A;Callaway C;Perman SM;Guerrero M;Aisiku IP;Seethala RR;Co IN;Madhok DY;Darger B;Kim DY;Spence L;Scalea TM;Stein DM
我们试图通过一项东部创伤外科协会（EAST）多中心回顾性研究来确定自杀性上吊的结局以及目标温度管理（TTM）对上吊诱导的心脏骤停（CA）的影响。我们分析了1992年1月至2015年12月的悬吊患者数据和TTM变量。脑功能分类（CPC）评分为1或2被认为是良好的神经功能结局，而CPC为3或4被认为是不良结局。分类和回归树（CART）递归分割用于开发生存和神经结局的多变量预测模型。本研究共分析了来自17个中心的692例上吊患者。总生存率为77%，CA生存率为28.6%。CA患者比非CA患者有更高的疾病严重程度和更差的结局。在175例存活至入院的CA患者中，81例患者（46.3%）接受了心脏骤停后TTM。TTM CA患者的未校正生存率（24.7% vs 39.4%，p <0.05）和良好神经功能结局（19.8% vs 37.2%，p <0.05）均低于非TTM CA患者。然而，当对入院GCS为3 - 8的患者进行亚组分析时，TTM和非TTM CA生存率（23.8% vs 30.0%，p = 0.37）和良好神经功能结局（18.8% vs 28.7%，p = 0.14）之间的差异不显著。TTM实施和心脏骤停后管理在参与中心之间存在差异。CART模型识别了预测悬吊和TTM患者良好和不良结局的变量，具有良好的准确性。CA悬挂患者的预后比非CA患者差。与非TTM患者相比，TTM CA患者的未校正生存率和神经功能结局更差。这些发现可能是由于他们的疾病严重程度较高，可变的TTM实施，以及心脏骤停后管理的差异。未来的前瞻性研究是必要的，以确定TTM对绞刑结果的影响，并验证我们的CART模型。治疗研究，III级;预后研究，III级
We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study. We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category (CPC) score of 1 or 2 was considered good neurologic outcome, while CPC of 3 or 4 was considered poor outcome. Classification and Regression Trees (CART) recursive partitioning was used to develop multivariate predictive models for survival and neurological outcome. Total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-cardiac arrest TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p<0.05) and good neurologic outcome (19.8% vs 37.2%, p<0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with admission GCS of 3–8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p=0.37) and good neurologic outcome (18.8% vs 28.7%, p=0.14) were not significant. TTM implementation and post-cardiac arrest management varied between the participating centers. CART models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy. CA hanging patients had worse outcome than non-CA patients. TTM CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-cardiac arrest management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our CART models. Therapeutic study, level III; prognostic study, level III