Daniel Zeymer-von Metnitz, Taoufik Ouarrak, Kurt Huber, Marko Noc, Steffen Desch, Anne Freund, Uwe Zeymer, Holger Thiele, Janine Pöss
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引用次数: 0
Abstract
Background: Mild induced hypothermia (MIH) is often applied in patients with cardiac arrest (CA), but its impact on patients with infarct-related cardiogenic shock (CS) and CA remains unclear.
Objectives: To evaluate the characteristics and outcomes of patients with infarct-related CS and CA who received MIH versus those who did not in the randomized CULPRIT-SHOCK trial and the accompanying registry.
Methods: We included patients with CS and CA from the CULPRIT-SHOCK trial and registry. The primary endpoint was 1-year mortality. Secondary endpoints included death or renal replacement therapy within 30 days. A multivariate regression analysis was performed for 1-year mortality, adjusted for relevant baseline parameters.
Results: Among 550 patients with CA, 288 (52.4%) received MIH. Patients treated with MIH were younger (64 vs. 67 years, P=0.03), had higher rates of mechanical ventilation (94.5% vs. 78.8%, p<0.01), and higher mean arterial pressure (82 vs. 76 mmHg, P=0.002). The unadjusted hazard ratio (HR) for 1-year mortality favored MIH (HR: 0.77, 95% confidence interval [CI]: 0.61-0.97, P=0.024); however, after multivariate adjustment, this effect was not statistically significant (HR: 0.83, 95% CI: 0.64-1.09, P=0.18). MIH was associated with a higher need for renal replacement therapy (15.2% vs. 7.5%, P=0.005) and less use of mechanical circulatory support (21.2% vs. 34.2%, P<0.001).
Conclusions: In this retrospective analysis MIH was not significantly associated with lower 1-year mortality in patients with infarct-related CS and CA. Because of the numerically lower mortality rate, further research is necessary to clarify the role of MIH in this patient population.
背景：轻度诱发性低温（MIH）常用于心脏骤停（CA）患者，但其对梗死相关性心源性休克（CS）和CA患者的影响尚不清楚。目的：在随机的罪魁祸首-休克试验和伴随的登记中，评估接受MIH治疗的梗死相关CS和CA患者与未接受MIH治疗的患者的特征和结果。方法：我们纳入了罪魁祸首-休克试验和登记处的CS和CA患者。主要终点为1年死亡率。次要终点包括30天内死亡或肾脏替代治疗。对1年死亡率进行多变量回归分析，并根据相关基线参数进行调整。结果：550例CA患者中，288例（52.4%）接受了MIH治疗。接受MIH治疗的患者更年轻（64岁vs. 67岁，P=0.03），机械通气率更高（94.5% vs. 78.8%）。结论：在这项回顾性分析中，MIH与梗死相关CS和CA患者较低的1年死亡率没有显著相关。由于死亡率较低，有必要进一步研究阐明MIH在该患者群体中的作用。试验注册：ClinicalTrials.gov标识符：NCT01927549。
期刊介绍：
The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes.
Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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