Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest
Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest
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DOI：
10.1016/j.resuscitation.2015.06.021
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发表时间：
2015-11-01
期刊：
影响因子：
6.5
通讯作者：
Hassager, Christian
中科院分区：
文献类型：
--
作者：
Kjaergaard, Jesper;Nielsen, Niklas;Hassager, Christian
目的：院外心脏骤停（OHCA）复苏前和复苏期间缺氧损伤的严重程度与自发循环恢复时间（ROSC）之间存在似是而非的关系，并且一直与不良结局相关。目标温度管理（TTM）的效果在整个时间范围内可能与ROSC不同。本研究调查了针对33°C而不是36°C对ROSC预后重要性时间的可能有益影响。方法：在TTM试验（NEJM 2013）的预定义子研究中，我们研究了180天后以脑功能分类（CPC）量表和改良Rankin量表（mRS）评估的ROSC时间、TTM水平与死亡率和神经预后之间的关系。结果：ROSC时间延长与死亡率增加显著相关，风险比（HR）为1.02 /分钟（95% CI 1.01-1.02）。TTM水平不改变时间与ROSC和死亡率的相关性，p（交互作用）= 0.85。延长ROSC时间与CPC （CPC 1-2组p = 0.008）和mRS （mRS 0-3组p = 0.17）良好神经预后的存活几率降低相关，与If m水平无显著相互作用。结论：ROSC时间仍然是昏迷OHCA患者死亡风险和不良神经预后风险的重要预后因素。在ROSC的任何时间，与36℃相比，在TTM中以33℃为目标与降低死亡率或不良神经系统预后风险方面的益处无关。(C) 2015 Elsevier Ireland Ltd。版权所有。
Aim: Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest (OHCA), and has consistently been associated with adverse outcome. The effect of Targeted Temperature Management (TTM) may not be similar over the full spectrum of time to ROSC. This study investigated the possible beneficial effect of targeting 33 degrees C over 36 degrees C on the prognostic importance of time to ROSC.Methods: In predefined sub-study of the TTM-trial (NEJM 2013) we investigated the relationship between time to ROSC, level of TTM and mortality and neurological outcome as assessed by the Cerebral Performance Category (CPC) scale and modified Rankin Scale (mRS) after 180 days.Results: Prolonged time to ROSC was significantly associated with increased mortality with a hazard ratio (HR) of 1.02 per minute (95% CI 1.01-1.02). Level of TTM did not modify the association of time to ROSC and mortality, p(interaction) = 0.85. Prolonged time to ROSC was associated with reduced odds of surviving with a favorable neurological outcome for CPC (p = 0.008 for CPC 1-2) and mRS (p = 0.17, mRS 0-3) with no significant interaction with level of If M.Conclusion: Time to ROSC remains a significant prognostic factor in comatose OHCA patients with regards to risk of death and risk of adverse neurological outcome. For any time to ROSC, targeting 33 degrees C in TTM was not associated with benefit with regards to reducing mortality or risk of adverse neurological outcome compared to targeting 36 degrees C. (C) 2015 Elsevier Ireland Ltd. All rights reserved.