Endovascular cooling versus standard femoral catheters and intravascular complications: A propensity-matched cohort study
Endovascular cooling versus standard femoral catheters and intravascular complications: A propensity-matched cohort study
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DOI：
10.1016/j.resuscitation.2017.12.014
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发表时间：
2018-03-01
期刊：
影响因子：
6.5
通讯作者：
Sauneuf, Bertrand
中科院分区：
文献类型：
--
作者：
Andremont, Olivier;du Cheyron, Damien;Sauneuf, Bertrand
背景：靶向温度管理(TTM)有助于改善心跳骤停后以可电击节律成功复苏的成年人的神经预后。血管内降温导管在ICU中被广泛用于诱导和维持目标温度。该研究的目的是比较使用冷却导管和标准中心静脉导管的并发症风险。材料和方法：在这项前瞻性的单中心队列研究中，我们纳入了所有在2012年8月至2014年11月期间因成功复苏心脏骤停而住进重症监护室并需要血管内TTM(Coolgard(R)，Zoll(TM)Medical Corporation，USA)的患者。我们将血管内冷却导管队列与3SITES试验中512根股中心静脉导管的回顾历史队列相匹配，以比较血栓和感染并发症。结果：总体而言，108名患者纳入冷却队列，其中89例有超声多普勒。对照组导尿时间为4.9天，TTM组为4.2天(P=0.08)。经倾向性评分匹配后，冷凝组(n=75)血栓并发症明显多于对照组(n=75)(12/75(16%)对0/75(0%，P=0.005)，4例患者出现主要并发症。每组有8个定植导管(11%)(p>；0.99)，没有患者发生导管相关的血流感染。结论：在我们的倾向评分匹配研究中，与标准中心静脉导管相比，血管内冷却导管与静脉导管相关血栓形成的风险增加。(C)2017年，爱思唯尔爱尔兰有限公司出版。
Background: Targeted temperature management (TTM) contributes to improved neurological outcome in adults who have been successfully resuscitated after cardiac arrest with shockable rhythm. Endovascular cooling catheters are widely used to induce and maintain targeted temperature in the ICU. The aim of the study was to compare the risk of complications with cooling catheters and standard central venous catheters.Materials and methods: In this prospective single-centre cohort study, we included all patients admitted to an intensive care unit for successfully resuscitated cardiac arrest that required endovascular TTM (Coolgard (R), Zoll (TM) Medical corporation, MA, USA), between August 2012 and November 2014, inclusive. We matched the endovascular cooling catheter cohort with a retrospective historical cohort of 512 central femoral venous catheters from the 3SITES trial to compare thrombotic and infectious complications.Results: Overall, 108 patients were included in the cooling cohort, of which 89 had ultrasound doppler. The duration of catheterization was 4.9 days in the control group versus 4.2 days in the TTM group (p = 0.08). After propensity-score matching, there were significantly more thrombotic complications in the cooling (n = 75) than in the control (n = 75) group (12 of 75 (16%) versus 0 of 75 (0%), respectively, p = 0.005), and 4 patients presented major complications. There were 8 colonized catheters in each group (11%) (p > 0.99), and none of the patients had a catheter-related bloodstream infection.Conclusions: In our propensity-score matched study, endovascular cooling catheters were associated with an increased risk of venous catheter-related thrombosis compared to standard central venous catheters. (c) 2017 Published by Elsevier Ireland Ltd.