Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia
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DOI：
10.1056/nejmoa003289
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发表时间：
2002-02-21
影响因子：
158.5
通讯作者：
Smith, K
中科院分区：
文献类型：
--
作者：
Bernard, SA;Gray, TW;Smith, K
背景：医院外心脏骤停很常见，而且预后不佳。对实验动物的研究表明，自主循环恢复后不久诱导的低温可能会改善神经系统的结果，但在人类中还没有结论性的研究。在一项随机对照试验中，我们比较了中度低温和常体温对院外心脏骤停复苏后仍昏迷的患者的影响。方法：研究对象为 77 名患者，他们被随机分配接受低温治疗（在自主循环恢复后 2 小时内将核心体温降至 33 摄氏度，并维持该温度 12 小时）或常体温治疗。主要结局指标是出院时的存活率，神经功能足够好，可以出院回家或康复机构。结果：低温组和正常体温组患者的人口统计学特征相似。接受低温治疗的 43 名患者中有 21 名（49%）存活下来，并获得了良好的结果，即出院回家或前往康复机构，而接受正常体温治疗的 34 名患者中有 9 名（26%，P=0.046）。调整年龄和从虚脱到恢复自主循环的时间的基线差异后，与正常体温相比，低温治疗获得良好结果的比值比为 5.25（95% 置信区间，1.47 至 18.76；P=0.011）。体温过低与较低的心脏指数、较高的全身血管阻力和高血糖有关。不良事件的发生频率没有差异。结论：我们的初步观察表明，中度低温治疗似乎可以改善院外心脏骤停复苏后昏迷患者的预后。版权所有 (C) 2002 马萨诸塞州医学会。
Background: Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest.Methods: The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33degreesC within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility.Results: The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome -- that is, they were discharged home or to a rehabilitation facility -- as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events.Conclusions: Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest. Copyright (C) 2002 Massachusetts Medical Society.