{"title":"治疗性体温过低:我们应该停止吗?","authors":"Ana Viana Tejedor","doi":"10.1016/S1131-3587(15)30029-7","DOIUrl":null,"url":null,"abstract":"<div><p>Current international guidelines recommend therapeutic hypothermia for patients who have survived a witnessed cardiac arrest to minimize neurological damage due to postischemic reperfusion. This recommendation is based mainly on the results of two randomized, controlled trials that included 352 patients and on supporting evidence from the field of neonatal asphyxia that also demonstrated the neuroprotective effect of hypothermia. However, the use of hypothermia in the context of a cardiac arrest has been called into question in the wake of a recently published randomized trial that included 939 patients and which found that hypothermia at 33 °C offered no benefits over maintaining a temperature of 36 °C. Moreover, another recent study has questioned the usefulness of starting hypothermia early in the prehospital phase. This article contains a review of the evidence available on the use of hypothermia, areas of uncertainty and strategies for using the technique. It concludes that there is sufficient evidence to support the continued use of hypothermia in the majority of patients who suffer a cardiac arrest and have a heart rhythm susceptible to defibrillation, pending the results of new studies using a range of target temperatures (32-36 °C) and treatment durations.</p></div>","PeriodicalId":34926,"journal":{"name":"Revista Espanola de Cardiologia Suplementos","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1131-3587(15)30029-7","citationCount":"0","resultStr":"{\"title\":\"Hipotermia terapéutica: ¿lo dejamos?\",\"authors\":\"Ana Viana Tejedor\",\"doi\":\"10.1016/S1131-3587(15)30029-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Current international guidelines recommend therapeutic hypothermia for patients who have survived a witnessed cardiac arrest to minimize neurological damage due to postischemic reperfusion. This recommendation is based mainly on the results of two randomized, controlled trials that included 352 patients and on supporting evidence from the field of neonatal asphyxia that also demonstrated the neuroprotective effect of hypothermia. However, the use of hypothermia in the context of a cardiac arrest has been called into question in the wake of a recently published randomized trial that included 939 patients and which found that hypothermia at 33 °C offered no benefits over maintaining a temperature of 36 °C. Moreover, another recent study has questioned the usefulness of starting hypothermia early in the prehospital phase. This article contains a review of the evidence available on the use of hypothermia, areas of uncertainty and strategies for using the technique. It concludes that there is sufficient evidence to support the continued use of hypothermia in the majority of patients who suffer a cardiac arrest and have a heart rhythm susceptible to defibrillation, pending the results of new studies using a range of target temperatures (32-36 °C) and treatment durations.</p></div>\",\"PeriodicalId\":34926,\"journal\":{\"name\":\"Revista Espanola de Cardiologia Suplementos\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2015-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/S1131-3587(15)30029-7\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revista Espanola de Cardiologia Suplementos\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1131358715300297\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista Espanola de Cardiologia Suplementos","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1131358715300297","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Current international guidelines recommend therapeutic hypothermia for patients who have survived a witnessed cardiac arrest to minimize neurological damage due to postischemic reperfusion. This recommendation is based mainly on the results of two randomized, controlled trials that included 352 patients and on supporting evidence from the field of neonatal asphyxia that also demonstrated the neuroprotective effect of hypothermia. However, the use of hypothermia in the context of a cardiac arrest has been called into question in the wake of a recently published randomized trial that included 939 patients and which found that hypothermia at 33 °C offered no benefits over maintaining a temperature of 36 °C. Moreover, another recent study has questioned the usefulness of starting hypothermia early in the prehospital phase. This article contains a review of the evidence available on the use of hypothermia, areas of uncertainty and strategies for using the technique. It concludes that there is sufficient evidence to support the continued use of hypothermia in the majority of patients who suffer a cardiac arrest and have a heart rhythm susceptible to defibrillation, pending the results of new studies using a range of target temperatures (32-36 °C) and treatment durations.
期刊介绍:
Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.