PurposeRecent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome.MethodsWe used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale.ResultsBetween May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome.ConclusionsWe report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in “no flow” duration.

中文翻译：

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心脏骤停后使用有针对性的体温管理的时间趋势及其与结果的关联：来自巴黎猝死专家中心的见解

目的最近对疗效的怀疑可能导致昏迷心脏骤停 (CA) 患者对靶向体温管理 (TTM) 失去兴趣，对结果产生不确定的影响。我们旨在确定 TTM 使用的变化，并评估这种变化与神经系统结果之间的关系。方法我们使用了从猝死专家中心 (SDEC) 注册处前瞻性收集的 Utstein 数据（从位于该地区的所有二级和三级医院采集 CA 数据）。 2011 年 5 月至 2017 年 12 月期间，法国大巴黎地区）。包括所有自主循环稳定恢复（ROSC）的非创伤性 OHCA 患者病例。在对潜在混杂因素进行调整后，我们使用脑功能分类 (CPC) 量表评估了 TTM 使用随时间的变化与出院时神经功能恢复之间的关系。 结果 2011 年 5 月至 2017 年 12 月，分析中保留了 3925 名患者，其中 1847 名 (47%)收到 TTM。与没有 TTM 的患者相比，TTM 患者出院时的良好神经学结果（CPC 1 或 2）率更高（33% vs 15%，P < 0.001）。CA 的性别、年龄和位置多年来没有变化。旁观者 CPR 从 2011 年的 55% 增加到 2017 年的 73%（P < 0.001），无流量时间超过 3 分钟的患者从 53% 减少到 38%（P < 0.001）。TTM 的使用率从 2011 年的 55% 下降到 2017 年的 37%（P < 0.001）。同时，神经功能恢复良好的患者比例保持稳定（19%～23%，P=0.76）。调整后，CA 发生的年份与结果无关。结论我们报告近年来心脏骤停后患者中 TTM 的使用逐渐减少。在此期间，尽管旁观者启动的复苏增加且“无血流”持续时间减少，但神经系统结果保持稳定。