BACKGROUND Moderate therapeutic hypothermia is currently recommended to improve neurologic outcomes in adults with persistent coma after resuscitated out-of-hospital cardiac arrest. However, the effectiveness of moderate therapeutic hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) is debated. METHODS We performed an open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in patients with coma who had been admitted to the intensive care unit (ICU) after resuscitation from cardiac arrest with nonshockable rhythm. The primary outcome was survival with a favorable neurologic outcome, assessed on day 90 after randomization with the use of the Cerebral Performance Category (CPC) scale (which ranges from 1 to 5, with higher scores indicating greater disability). We defined a favorable neurologic outcome as a CPC score of 1 or 2. Outcome assessment was blinded. Mortality and safety were also assessed. RESULTS From January 2014 through January 2018, a total of 584 patients from 25 ICUs underwent randomization, and 581 were included in the analysis (3 patients withdrew consent). On day 90, a total of 29 of 284 patients (10.2%) in the hypothermia group were alive with a CPC score of 1 or 2, as compared with 17 of 297 (5.7%) in the normothermia group (difference, 4.5 percentage points; 95% confidence interval [CI], 0.1 to 8.9; P = 0.04). Mortality at 90 days did not differ significantly between the hypothermia group and the normothermia group (81.3% and 83.2%, respectively; difference, -1.9 percentage points; 95% CI, -8.0 to 4.3). The incidence of prespecified adverse events did not differ significantly between groups. CONCLUSIONS Among patients with coma who had been resuscitated from cardiac arrest with nonshockable rhythm, moderate therapeutic hypothermia at 33°C for 24 hours led to a higher percentage of patients who survived with a favorable neurologic outcome at day 90 than was observed with targeted normothermia. (Funded by the French Ministry of Health and others; HYPERION ClinicalTrials.gov number, NCT01994772.).

中文翻译：

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具有不可电击心律的心脏骤停的目标温度管理。

背景技术目前建议在院外心脏骤停复苏后，持续性昏迷的成年人进行适度的低温治疗以改善神经系统的预后。然而，对于具有不可电击的节律（无搏动或无脉动的电活动）的患者，适度的低温治疗是否有效尚有争议。方法我们对在重症监护病房（ICU）昏迷的患者进行了中度治疗性低温（头24小时内为33°C）与目标体温正常（37°C）进行比较的开放标签，随机对照试验。心脏骤停复苏并伴有不可节律的心跳后。主要结局是生存期，神经系统结局良好，在随机分配后第90天使用脑功能分级（CPC）量表（范围为1至5）进行评估 得分越高表示残疾越大）。我们将良好的神经系统预后定义为CPC评分为1或2。结果评估是盲目的。还评估了死亡率和安全性。结果2014年1月至2018年1月，来自25个ICU的584例患者接受了随机分组，其中581例被纳入分析（3例患者撤回了同意）。在第90天，体温过低组的284例患者中有29例活着，CPC得分为1或2，而正常体温过低的组中297例中有17例（5.7％）存活（差异为4.5个百分点） ； 95％置信区间[CI]为0.1到8.9； P = 0.04）。亚低温组和常温组之间90天死亡率无显着差异（分别为81.3％和83.2％；差异为-1.9个百分点； 95％CI为-8.0至4.3）。两组之间的预定不良事件发生率无显着差异。结论在因心脏骤停而无法休克的节奏恢复昏迷的患者中，在33°C进行24小时的适度低温治疗比在正常体温正常的情况下，在90天存活的神经功能良好的患者所占的百分比更高。（由法国卫生部和其他机构资助； HYPERION ClinicalTrials.gov编号，NCT01994772。）。在33°C下进行24小时的适度治疗性低温治疗比在正常体温正常情况下观察到的存活率高，在90天时具有良好的神经系统预后的患者所占的百分比更高。（由法国卫生部和其他机构资助； HYPERION ClinicalTrials.gov编号，NCT01994772。）。在33°C下进行24小时的适度治疗性低温治疗比在正常体温正常情况下观察到的存活率高，在90天时具有良好的神经系统预后的患者所占的百分比更高。（由法国卫生部和其他机构资助； HYPERION ClinicalTrials.gov编号，NCT01994772。）。