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，定义为全身冷却至32 - 36° C，持续12-24小时，目前推荐用于从院外心脏骤停（OHCA）复苏中恢复的昏迷成人，以减轻再锡永损伤，保护神经功能，提高生存率。尽管TTM已被明确证明对75岁以下的患者贝内，但从未在老年人中进行过专门评估-老年人是发达国家增长最快的人口。由于那些75岁及以上的人具有相对较短的基线预期寿命，并且通常具有使他们处于更大的治疗并发症风险的多种共病，因此必须将他们视为成人OHCA幸存者的明显不同的子集。在这个年龄组中，关于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提高生存率（CARES）数据集分析老年人年龄亚组的结局。本提案的目的是采用回顾性研究设计，评估TTM对老年OHCA幸存者生存和神经保护的有效性。本研究的基本原理是，TTM已被外推至其已证实的适应症之外，以纳入这一无令人信服的证据且后果未知的可接受人群，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，老年患者提供TTM将有较低的住院死亡率和更有利的神经系统状态在出院时比那些没有治疗。使用CARES数据，我们将比较OHCA存活者的比例，年龄≥ 75岁，在出院时存活于预定义的年龄类别。我们还将比较OHCA存活者出院时良好神经系统状态（脑功能分类[CPC]）的比例，年龄≥ 75岁，在预定义的年龄类别中。这项研究意义重大，因为它将产生一个大的，强大的，多中心的，比较有效性分析TTM在老年OHCA幸存者。它的创新之处在于，我们将访问一个独特的，未开发的存储库的前瞻性收集和验证的数据，以确定有效的TTM在老年人，这是从来没有这样做过。我们的研究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研究结果，并为TTM在老年人中的适当应用提供更高水平的科学证据。这一研究路线将导致重要的临床实践变化（即，对现有TTM指南进行特定年龄的修改），并确保为这一快速增长的社会群体中的个人提供最高质量的护理，使他们能够活得更长，更充实。

 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.