Active surface cooling protocol to induce mild therapeutic hypothermia after out-of-hospital cardiac arrest: a retrospective before-and-after comparison in a single hospital.
Active surface cooling protocol to induce mild therapeutic hypothermia after out-of-hospital cardiac arrest: a retrospective before-and-after comparison in a single hospital.
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DOI：
10.1097/ccm.0b013e3181b7f59c
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发表时间：
2009-12
影响因子：
8.8
通讯作者：
Kim F
中科院分区：
文献类型：
--
作者：
Don CW;Longstreth WT Jr;Maynard C;Olsufka M;Nichol G;Ray T;Kupchik N;Deem S;Copass MK;Cobb LA;Kim F
本研究评估了在到达社区医院后实施治疗性低温（TH）方案是否改善了最初发现有室颤（VF）、无脉性电活动（PEA）或心搏停止，然后成功地从院外心脏骤停复苏。这是一项回顾性研究，与在华盛顿西雅图的Harborview医疗中心实施方案之前的患者相比，我们评估了491例连续的成人院外，非创伤性心脏骤停谁提出了2000年1月1日至2004年12月31日。2002年11月18日，针对心脏骤停复苏的昏迷患者启动了主动冷却TH方案，使用冰袋、冷却毯或冷却垫来达到32-34 °C的温度。人口统计学和结果来自医疗记录和紧急医疗数据库。主要结局是生存率和出院时与TH方案相关的良好神经功能结局。使用多变量回归进行校正分析。在TH期间，204名患者被送往急诊室;其中132名（65%）最终体温低于34 °C。在72例未达到目标体温的患者中：40例（20%）在急诊室或入院后不久死亡，15例（7%）恢复意识，4例（2%）有禁忌症，13例（6%）体温升高或未记录使用TH方案。在此之前，287名患者中没有一人接受过主动降温。在TH期入院的患者在前12小时内的平均食管温度为34.1°C，而TH期前为35.2°C（p<0.01）。在TH期，VF初始节律患者的出院生存率有所改善（OR 1.88，95%置信区间（CI）1.03-3.45），但非VF患者无改善（OR 1.17，95% CI 0.66-2.05）。在校正分析中，与早期相比，TH期VF患者的生存率有改善的趋势（OR 1.71，95% CI 0.85-3.46），神经功能结局良好（OR 2.62，95% CI 1.1-6.27）。在初始心律为PEA或心搏停止的患者中未观察到这种获益。治疗性低温期与初始心律为VF的患者的神经功能结局显著改善相关，但与其他心律的患者无关。
This study evaluated whether implementation of a therapeutic hypothermia (TH) protocol upon arrival in a community hospital improved survival and neurologic outcomes in patients initially found to have ventricular fibrillation (VF), pulseless electrical activity (PEA), or asystole and then successfully resuscitated from out-of-hospital cardiac arrest This is a retrospective study of patients who presented after implementation of a TH-protocol compared to those who presented before the protocol was implemented at Harborview Medical Center, Seattle, Washington. We evaluated 491 consecutive adults with out-of-hospital, non-traumatic cardiac arrest who presented between January 1, 2000 and December 31, 2004. An active cooling TH-protocol using ice packs, cooling blankets, or cooling pads to achieve a temperature of 32–34 °C was initiated on November 18, 2002 for unconscious patients resuscitated from cardiac arrest. Demographics and outcomes were obtained from medical records and an emergency medical database. The primary outcomes were survival and favorable neurologic outcome at discharge associated with the TH-protocol. An adjusted analysis was performed using a multivariate regression. During the TH-period, 204 patients were brought to emergency department; of these, 132 (65%) ultimately achieved temperatures of less than 34 °C. Of the 72 patients who did not achieve goal temperatures: 40 (20%) died in the emergency department or shortly after being admitted to the hospital, 15 (7%) regained consciousness, 4 (2%) had contraindications 13 (6%) had temperature increase or did not have documented use of the TH protocol. In the prior period, none of the 287 patients received active cooling. Patients admitted in the TH-period had a mean esophageal temperature of 34.1°C during the first 12 hours compared to 35.2°C in the pre-TH period (p<0.01). Survival to hospital discharge improved in TH period in patients with an initial rhythm of VF (OR 1.88, 95% confidence interval (CI) 1.03–3.45), however not in patients with non-VF (OR 1.17, 95% CI 0.66–2.05). In adjusted analysis, VF patients during the TH period trended toward improved survival (OR 1.71, 95% CI 0.85–3.46) and had favorable neurologic outcome (OR 2.62, 95% CI 1.1–6.27) compared to the earlier period. This benefit was not observed in patients whose initial rhythm was PEA or asystole. The therapeutic hypothermia period was associated with a significant improvement in neurologic outcomes in patients whose initial rhythm was VF, but not in patients with other rhythms.