Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: A systematic review and meta-analysis of randomized and non-randomized studies
Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: A systematic review and meta-analysis of randomized and non-randomized studies
复制标题
DOI：
10.1016/j.resuscitation.2011.07.031
复制
发表时间：
2012-02-01
期刊：
影响因子：
6.5
通讯作者：
Callaway, Clifton W.
中科院分区：
文献类型：
--
作者：
Kim, Young-Min;Yim, Hyeon-Woo;Callaway, Clifton W.
背景：低温治疗（TH）对于心脏骤停（CA）后恢复自主循环且初始心律不可电击的昏迷成年患者的益处尚不确定。我们评估了 TH 是否可以降低从不可电击 CA 复苏的昏迷成人中的死亡率并改善神经系统结果。方法：我们检索了截至 2010 年 3 月的 PubMed、EMBASE、CENTRAL 和 BIOSIS，以确定在不可电击 CA 后使用 TH 的研究。选择比较 TH 和标准护理或正常体温下的生存率或神经学结果的随机和非随机研究（RS 和 NRS）。我们与作者进行了通信，以澄清已发表文章中缺失的数据。个体和汇总统计数据计算为风险比 (RR)，置信区间 (CI) 为 95%。固定效应模型和随机效应模型均用于荟萃分析。结果：荟萃分析中纳入了两个 RS 和 12 个 NRS 并分别进行了分析。两种 RS 6 个月死亡率的汇总 RR 为 0.85 (95% CI 0.65-1.11)。在随机效应模型中，10 NRS 的院内死亡率的汇总 RR 为 0.84 (95% CI 0.78-0.92)，出院时神经系统预后不良的汇总 RR 为 0.95 (95% CI 0.90-1.01)。在对院外 CA 的 NRS 进行亚组分析时，院内死亡率的汇总 RR 为 0.86 (95% CI 0.76-0.99)，出院时神经系统预后不良的汇总 RR 为 0.96 (95% CI 0.90-1.02)。对于前瞻性 NRS，院内死亡率的汇总 RR 为 0.76 (95% CI 0.65-0.89)，出院时不良神经系统结局的汇总 RR 为 0.96 (95% CI 0.90-1.02)。大多数研究存在很大的偏倚风险，而且证据的总体质量非常低。解释：TH 与非电击 CA 复苏的成人患者院内死亡率降低相关。然而，大多数研究存在很大的偏倚风险，而且证据质量非常低。进一步的高质量随机临床试验将证实 TH 对该人群的实际益处。 (C) 2011 Elsevier Ireland Ltd. 保留所有权利。
Background: The benefit of therapeutic hypothermia (TH) for comatose adult patients with return of spontaneous circulation after cardiac arrest (CA) with non-shockable initial rhythms is uncertain. We evaluated whether TH reduces mortality and improves neurological outcome in comatose adults resuscitated from non-shockable CA.Methods: We searched PubMed, EMBASE, CENTRAL, and BIOSIS through March 2010, to identify studies using TH after non-shockable CA. Randomized and non-randomized studies (RS and NRS) comparing survival or neurological outcome in TH and standard care or normothermia were selected. We corresponded with authors to clarify data missing from published articles. Individual and pooled statistics were calculated as risk ratios (RRs) with 95% confidence interval (CI). Both fixed-and random-effects models were used for both meta-analyses.Findings: Two RS and twelve NRS were included in the meta-analysis and separately analyzed. The pooled RR for 6-month mortality of two RS was 0.85 (95% CI 0.65-1.11). The pooled RR for in-hospital mortality for 10 NRS was 0.84 (95% CI 0.78-0.92) and for poor neurological outcome on discharge was 0.95 (95% CI 0.90-1.01) in random-effects model. In subgroup analysis for the NRS with out-of-hospital CA, the pooled RR for in-hospital mortality was 0.86 (95% CI 0.76-0.99) and for the poor neurological outcome on discharge was 0.96 (95% CI 0.90-1.02). For the prospective NRS, the pooled RR for in-hospital mortality was 0.76 (95% CI 0.65-0.89) and for the poor neurological outcome on discharge was 0.96 (95% CI 0.90-1.02). Most of studies had substantial risks of bias and overall quality of evidence was very low.Interpretation: TH is associated with reduced in-hospital mortality for adults patients resuscitated from non-shockable CA. However, most of the studies had substantial risks of bias and quality of evidence was very low. Further high quality randomized clinical trials would confirm the actual benefit of TH in this population. (C) 2011 Elsevier Ireland Ltd. All rights reserved.