Targeted temperature management effectiveness in the elderly: Insights from a large registry

 描述(申请人提供)：靶向体温管理(TTM)，有时仍被称为治疗性低温，定义为全身降温至32至36°C，持续12-24小时，目前推荐用于院外心脏骤停(UchA)复苏的昏迷成年人，以试图减轻再灌注损伤，保护神经功能，并提高存活率。尽管TTM已被明确证明适用于75岁以下的健康患者，但从未在老年人中进行过专门的评估--老年人是发达国家增长最快的人口。由于那些75岁及以上的人的基线预期寿命相对较短，并且经常合并多种疾病，使他们面临更大的治疗并发症风险，他们必须被视为成年uchA幸存者中截然不同的亚群。在这个年龄段，TTM存在巨大的不确定性，因此我们建议将其作为一个重要的知识差距来解决。我们将使用特征良好的心脏骤停登记以增强生存(CARE)数据集来分析老年人年龄亚组的结果。这项建议的目的，采用回溯性研究设计，旨在评估TTM对老年uchA幸存者的生存和神经保护的有效性。这项研究的基本原理是，TTM已被外推到其已证实的适应症之外，以包括这一脆弱人群，没有令人信服的证据和未知的后果，因此我们试图确定其在该队列中的有效性。我们的中心假设是，与未接受治疗的老年患者相比，接受TTM治疗的老年患者的住院死亡率更低，出院时的神经状况更好。使用CARE数据，我们将比较在预定义的年龄类别中，在出院时活着的75岁的uchA幸存者的比例。我们还将比较神经学状态良好的比例(出院时的大脑表现类别[CPC])，在预定义的年龄类别中，uchA幸存者=75岁。这项研究具有重要意义，因为它将产生一项大型的、稳健的、多中心的、对老年OtA幸存者的TTM的比较有效性分析。它的创新之处在于，我们将访问一个独特的、未开发的存储库，其中包含预期收集和验证的数据，以确定TTM在老年人中的有效性，这是以前从未做过的。我们的结果将为前瞻性队列研究提供初步数据，该研究将从外部证实我们的发现，并为TTM在老年人中的适当应用提供更高水平的科学证据。这一系列调查将导致重要的临床实践变化(即，针对年龄修改现有的TTM指南)，并确保在这一快速增长的社会阶层中为个人提供最高质量的护理，使他们能够活得更长、更有成就感。

 DESCRIPTION (provided by applicant): Targeted temperature management (TTM), occasionally still referred to as therapeutic hypothermia and de- fined as whole body cooling to between 32 and 36° C for 12-24 hours, is currently recommended for comatose adults recovering from out-of-hospital cardiac arrest (OHCA) resuscitation, in an attempt to attenuate reperfu- sion injury, preserve neurological function, and improve survival. Though TTM has been clearly shown to bene- fit patients less than 75 years of age, it has never been specifically evaluated in older adults - the fastest grow- ing demographic in developed countries. Since those 75 years of age and older have a relatively shorter base- line life expectancy, and often have multiple co-morbidities that put them at greater risk for complications of treatment, they must be considered a distinctly different subset of adult OHCA survivors. There is tremendous uncertainty regarding TTM in this age group, so we propose to address this as an important knowledge gap. We will analyze outcomes for age subgroups among the elderly using the well-characterized Cardiac Arrest Registry to Enhance Survival (CARES) dataset. The objective of this proposal, using a retrospective study de- sign, is to assess the effectiveness of TTM on survival and neuroprotection in geriatric OHCA survivors. The rationale for this study is that TTM has been extrapolated beyond its proven indication to include this vulnera- ble population with no convincing evidence and unknown consequences, so we seek to determine its effec- tiveness in this cohort. Our central hypothesis is that elderly patients provided TTM will have lower in-hospital mortality and more favorable neurological status at hospital discharge than those not treated. Using the CARES data, we will compare the proportion of OHCA survivors =75 years of age, alive at hospital discharge across predefined age categories. We will also compare the proportion of good neurological status (Cerebral Performance Category [CPC] at hospital discharge in OHCA survivors =75 years of age across predefined age categories. This research is significant because it will generate a large, robust, multi-center, comparative effec- tiveness analysis of TTM in geriatric OHCA survivors. It is innovative in that we will be accessing a unique, un- tapped repository of prospectively collected and validated data to determine the effectiveness of TTM in the elderly, which has never before been done. Our results will provide preliminary data for a prospective cohort study that will externally corroborae our findings and provide a higher level of scientific evidence regarding the appropriate application of TTM in the elderly. This line of investigation will lead to important clinical practce changes (i.e., age specific modification of existing TTM guidelines), and secure the highest quality of care for individuals in this rapidly growing segment of society, so that they can live longer and more fulfilling lives.