Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
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DOI：
10.1056/nejmoa1906661
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发表时间：
2019-12-12
影响因子：
158.5
通讯作者：
Reignier, J.
中科院分区：
文献类型：
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作者：
Lascarrou, J. -B.;Merdji, H.;Reignier, J.
研究背景目前推荐中度低温治疗以改善院外心脏骤停复苏后持续昏迷的成人的神经功能结局。然而，中度低温治疗对非电击心律患者的有效性（心搏停止或无脉电活动）是有争议的。方法我们进行了一个开放标签，随机，对照试验比较中度低温治疗（前24小时内33 ℃），目标体温正常（37摄氏度），对于心脏骤停复苏后进入重症监护室（ICU）的昏迷患者，心律不齐。主要结局是存活率和良好的神经功能结局，在随机化后第90天使用脑功能分类（CPC）量表（范围为1 - 5，评分越高表示残疾越大）进行评估。我们将良好的神经功能结局定义为CPC评分为1或2。结局评估设盲。从2014年1月到2018年1月，来自25个ICU的总共584名患者接受了随机分组，其中581名患者被纳入分析（3名患者撤回了知情同意书）。在第90天，低温组284例患者中有29例（10.2%）存活，CPC评分为1或2，而常温组297例患者中有17例（5.7%）存活（差异，4.5个百分点; 95%置信区间[CI]，0.1至8.9; P = 0.04）。低温组和常温组90天时的死亡率无显著差异（分别为81.3%和83.2%;差异为-1.9个百分点; 95%CI为-8.0至4.3）。预先指定的不良事件的发生率并没有显着groups.CONCLUSIONSAmong昏迷患者心脏骤停复苏nonshockable节奏，中度治疗性低温在33摄氏度24小时导致更高的百分比的患者谁存活了一个良好的神经功能的结果，在第90天比观察到有针对性的常温。
BACKGROUNDModerate therapeutic hypothermia is currently recommended to improve neurologic outcomes in adults with persistent coma after resuscitated out-of-hospital cardiac arrest. However, the effectiveness of moderate therapeutic hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) is debated.METHODSWe performed an open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33 degrees C during the first 24 hours) with targeted normothermia (37 degrees C) in patients with coma who had been admitted to the intensive care unit (ICU) after resuscitation from cardiac arrest with nonshockable rhythm. The primary outcome was survival with a favorable neurologic outcome, assessed on day 90 after randomization with the use of the Cerebral Performance Category (CPC) scale (which ranges from 1 to 5, with higher scores indicating greater disability). We defined a favorable neurologic outcome as a CPC score of 1 or 2. Outcome assessment was blinded. Mortality and safety were also assessed.RESULTSFrom January 2014 through January 2018, a total of 584 patients from 25 ICUs underwent randomization, and 581 were included in the analysis (3 patients withdrew consent). On day 90, a total of 29 of 284 patients (10.2%) in the hypothermia group were alive with a CPC score of 1 or 2, as compared with 17 of 297 (5.7%) in the normothermia group (difference, 4.5 percentage points; 95% confidence interval [CI], 0.1 to 8.9; P = 0.04). Mortality at 90 days did not differ significantly between the hypothermia group and the normothermia group (81.3% and 83.2%, respectively; difference, -1.9 percentage points; 95% CI, -8.0 to 4.3). The incidence of prespecified adverse events did not differ significantly between groups.CONCLUSIONSAmong patients with coma who had been resuscitated from cardiac arrest with nonshockable rhythm, moderate therapeutic hypothermia at 33 degrees C for 24 hours led to a higher percentage of patients who survived with a favorable neurologic outcome at day 90 than was observed with targeted normothermia.