Mild therapeutic hypothermia after cardiac arrest - effect on survival with good neurological outcome outside of randomised controlled trials: A registry-based analysis.

IF 4.2 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2024-10-01 Epub Date: 2024-05-27 DOI:10.1097/EJA.0000000000002016
Jürgen Knapp, Richard Steffen, Markus Huber, Sandra Heilman, Stefan Rauch, Michael Bernhard, Matthias Fischer
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引用次数: 0

Abstract

Background: For nearly 20 years, in international guidelines, mild therapeutic hypothermia (MTH) was an important component of postresuscitation care. However, recent randomised controlled trials have questioned its benefits. At present, international guidelines only recommend actively preventing fever, but there are ongoing discussions about whether the majority of cardiac arrest patients could benefit from MTH treatment.

Objective: The aim of this study was to compare the outcome of adult patients treated with and without MTH after cardiac arrest.

Design: Observational cohort study.

Setting: German Resuscitation Registry covering more than 31 million inhabitants of Germany and Austria.

Patients: All adult patients between 2006 and 2022 with out-of-hospital or in-hospital cardiac arrest and comatose on admission.

Main outcome measures: Primary endpoint: hospital discharge with good neurological outcome [cerebral performance categories (CPC) 1 or 2]. Secondary endpoint: hospital discharge. We used a multivariate binary logistic regression analysis to identify the effects on outcome of all known influencing variables.

Results: We analysed 33 933 patients (10 034 treated with MTH, 23 899 without MTH). The multivariate regression model revealed that MTH was an independent predictor of CPC 1/2 survival and of hospital discharge with odds ratio (95% confidence intervals) of 1.60 (1.49 to 1.72), P < 0.001 and 1.89 (1.76 to 2.02), P < 0.001, respectively.

Conclusion: Our data indicate the existence of a positive association between MTH and a favourable neurological outcome after cardiac arrest. It therefore seems premature to refrain from giving MTH treatment for the entire spectrum of patients after cardiac arrest. Further prospective studies are needed.

心脏骤停后的轻度治疗性低温--在随机对照试验之外对神经功能良好的存活率的影响:基于登记的分析。
背景:近 20 年来,在国际指南中,轻度治疗性低温疗法(MTH)一直是复苏后护理的重要组成部分。然而,最近的随机对照试验对其益处提出了质疑。目前,国际指南只建议积极预防发热,但关于大多数心脏骤停患者是否能从 MTH 治疗中获益的讨论仍在进行中:本研究旨在比较心脏骤停后接受和不接受 MTH 治疗的成年患者的预后:观察性队列研究:德国复苏注册中心,覆盖德国和奥地利的 3100 多万居民:2006年至2022年期间在院外或院内发生心脏骤停、入院时昏迷的所有成年患者:主要终点:出院时神经功能状况良好[脑功能分类(CPC)1或2]。次要终点:出院。我们使用多变量二元逻辑回归分析来确定所有已知影响变量对预后的影响:我们分析了 33 933 名患者(10 034 人接受了 MTH 治疗,23 899 人未接受 MTH 治疗)。多变量回归模型显示,MTH是CPC 1/2存活率和出院率的独立预测因素,其几率比(95%置信区间)为1.60(1.49至1.72),P 结论:我们的数据表明,MTH对CPC 1/2存活率和出院率存在积极影响:我们的数据表明,MTH 与心脏骤停后良好的神经功能预后之间存在正相关。因此,对所有心脏骤停患者都不给予 MTH 治疗似乎为时过早。还需要进一步的前瞻性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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