Objective

Evaluate trends in targeted temperature management with regards to temperature selection, its effect on neurologic outcomes at discharge, and compare this with recent large randomized controlled trial outcomes.

Design

Retrospective cohort study between January 2010 and December 2019.

Setting

Single large tertiary academic community hospital.

Patients

634 adult non-traumatic patients presenting with out of hospital cardiac arrest with persistent comatose state treated with active targeted temperature management.

Interventions, measurements, and Main results

473 patients received hypothermia of 33 °C and were compared to 161 patients who received targeted normothermia of 36.5 °C. The primary outcome was Cerebral Performance Category (CPC) at hospital discharge, with levels 1 or 2 considered good outcomes. Mortality, ICU days, ventilator days, and overall hospital stay length were secondary outcomes.

Patients receiving T33 had more favorable CPC outcomes when compared to patients receiving T36.5 (OR = 2.4 [1.3, 4.6], p = 0.006). Subgroup analysis of initial non-shockable rhythms demonstrated improved CPC scores (OR = 2.5, p = 0.04), however this was not maintained in the shockable rhythm group. T33 patients had a shorter length of stay. Mortality, ICU days, and ventilator days did not differ between the groups.

Conclusions

Out of hospital cardiac arrest patients with persistent comatose state treated with hypothermia of 33 °C had improved odds of discharge with good neurologic outcomes when compared to those treated with targeted normothermia. This improvement of outcomes appears to have been driven by the improved outcomes in the patients who had presented with non-shockable rhythm.

中文翻译：

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目标温度管理研究后院外心脏骤停的低温使用减少后的结果

客观的

评估目标温度管理在温度选择方面的趋势，它对出院时神经系统结果的影响，并将其与最近的大型随机对照试验结果进行比较。

设计

2010 年 1 月至 2019 年 12 月的回顾性队列研究。

环境

单一的大型三级学术社区医院。

患者

634 名出现院外心脏骤停且持续昏迷状态的成年非创伤性患者接受主动靶向温度管理治疗。

干预、测量和主要结果

473 名患者接受了 33 °C 的低温治疗，并与 161 名接受 36.5 °C 目标正常体温治疗的患者进行了比较。主要结果是出院时的脑功能分类 (CPC)，1 级或 2 级被认为是良好的结果。死亡率、ICU 天数、呼吸机天数和总住院时间是次要结果。

与接受 T36.5 的患者相比，接受 T33 的患者具有更有利的 CPC 结果（OR = 2.4 [1.3, 4.6]，p = 0.006）。初始不可电击节律的亚组分析表明 CPC 分数有所提高（OR = 2.5，p = 0.04），但是可电击节律组并未保持这一点。T33 患者的住院时间较短。两组之间的死亡率、ICU 天数和呼吸机天数没有差异。

结论

与接受目标常温治疗的患者相比，接受 33 °C 低温治疗的持续昏迷的出院心脏骤停患者出院几率更高，神经系统预后良好。这种结果的改善似乎是由出现不可电击心律的患者的结果改善所驱动的。