Aim

To investigate whether intentional cooling, achieved temperature and hypothermia duration were associated with in-hospital death in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest.

Methods

This is a retrospective analysis of the Extracorporeal Life Support Organization Registry. Patients 18–79 years of age who received ECPR between 2010 and 2019 were included. We compared outcomes for intentional cooling versus no intentional cooling. Then, among those who completed intentional cooling, we compared the outcomes between i) achieved temperature ≤ 34 °C, 34–36 °C, and > 36 °C, and ii) duration ≤ 36 °C for < 12 h, 12–48 h, and ≥ 48 h. The primary outcome was in-hospital mortality within 90 days. Cox proportional hazard models were generated with adjustment for covariates.

Results

Among 4,214 ECPR patients, 1,511 patients were included in the final analysis. After multivariable adjustment, there was no significant difference in in-hospital mortality between patients with intentional cooling and no intentional cooling (hazard ratio [HR], 1.06 [95% CI 0.93–1.21]; p = 0.394). In the 609 patients who completed intentional cooling, temperature at 34–36 °C had a significantly lower adjusted HR for in-hospital mortality compared with > 36 °C (HR, 0.73 [0.55–0.96]; p = 0.025). Moreover, temperature ≤ 36 °C for 12–48 h had a significantly lower adjusted HR for in-hospital mortality compared with ≤ 36 °C for < 12 h (HR, 0.69 [0.53–0.90]; p = 0.005).

Conclusion

Intentional cooling was not associated with lower in-hospital mortality in ECPR patients. However, among patients with intentional cooling, achieving temperature of 34–36 °C for 12–48 h was associated with lower in-hospital mortality.

中文翻译：

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在接受体外心肺复苏术治疗的患者中，有意降温、达到的体温和低温持续时间与住院死亡率之间的关系：ELSO 登记的分析

目标

研究在因难治性心脏骤停而接受体外心肺复苏 (ECPR) 治疗的患者中，有意降温、达到的体温和低温持续时间是否与院内死亡相关。

方法

这是对体外生命支持组织登记处的回顾性分析。纳入 2010 年至 2019 年期间接受 ECPR 的 18-79 岁患者。我们比较了有意降温与不有意降温的结果。然后，在那些完成有意降温的人中，我们比较了 i) 达到的温度 ≤ 34 °C、34–36 °C 和 > 36 °C，以及 ii) 持续时间 ≤ 36 °C for < 12 h、12– 48 小时和≥ 48 小时。主要结果是 90 天内的住院死亡率。Cox 比例风险模型是通过协变量调整生成的。

结果

在 4,214 名 ECPR 患者中，1,511 名患者被纳入最终分析。多变量调整后，有意降温和不降温的患者的住院死亡率没有显着差异（风险比 [HR] 为 1.06 [95% CI 0.93–1.21]；p  = 0.394）。在完成有意降温的 609 名患者中，与 > 36 °C 相比，34–36 °C 的温度对住院死亡率的调整 HR 显着降低（HR，0.73 [0.55–0.96]；p  = 0.025）。此外，与 ≤ 36 °C 持续 < 12 小时相比，温度≤ 36 °C 持续 12-48 小时的调整后的住院死亡率显着降低（HR，0.69 [0.53–0.90]；p  = 0.005）。

结论

在 ECPR 患者中，故意降温与较低的住院死亡率无关。然而，在有意降温的患者中，在 12-48 小时内达到 34-36°C 的温度与较低的住院死亡率相关。