Scandinavian Clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest
Scandinavian Clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest
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DOI：
10.1111/j.1399-6576.2008.01881.x
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发表时间：
2009-03-01
影响因子：
2.1
通讯作者：
Sunde, K.
中科院分区：
文献类型：
--
作者：
Castren, M.;Silfvast, T.;Sunde, K.
心脏骤停的幸存者遭受缺血性脑损伤，可能导致神经功能不良和死亡。发生的再灌注损伤与损伤性生化反应相关，其被轻度治疗性低温（MTH）抑制。在一些研究中，MTH已被证明是安全的，并发症少，生存率提高，并被国际复苏联络委员会推荐。本文的目的是推荐来自斯堪的纳维亚麻醉学和重症监护医学会（SSAI）的心脏骤停后MTH治疗的临床实践指南。相关研究是在SSAI治疗性低温工作组（SSAITFTH）的两次共识会议后通过科克伦对照试验中心注册中心和Medline的文献检索确定的。当高等级证据（推荐等级，戈尔）不可用时，评估证据并使用共识意见。虽然证明仅对初始室颤患者有益（戈尔A），但SSAITFTH也建议在恢复自主循环后，如果选择积极治疗，在初始无脉性电活动和心搏停止患者（戈尔D）中使用MTH。正常的伦理考虑、病前状态、总缺氧时间和一般状况应决定是否需要积极治疗。MTH应作为标准化治疗方案的一部分，并在适应症和治疗决定后尽早开始（戈尔E）。目前还没有足够的证据对诱导MTH的技术提出明确的建议，我们也不知道最佳的目标温度、冷却持续时间和复温时间。需要新的研究来解决MTH如何影响预后因素等问题。
Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).Relevant studies were identified after two consensus meetings of the SSAI Task Force on Therapeutic Hypothermia (SSAITFTH) and via literature search of the Cochrane Central Register of Controlled Trials and Medline. Evidence was assessed and consensus opinion was used when high-grade evidence (Grade of Recommendation, GOR) was unavailable. A management strategy was developed as a consensus from the evidence and the protocols in the participating countries.Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic factors.