Randomized controlled trial of internal and external targeted temperature management methods inpost- cardiac arrest patients.
BACKGROUND
Targeted temperature managementpost-cardiac arrest is currently implemented using various methods, broadly categorized as internal and external. This study aimed to evaluate survival-to-hospital discharge and neurological outcomes (Glasgow-Pittsburgh Score) ofpost-cardiac arrest patients undergoing internal cooling verses external cooling.
背景：心髒驟停後複蘇應用目標體溫管理可采用不同的方法，大致分為體內降溫與外部降溫2種方法。本研究旨在針對采用體內和外部降溫的心髒驟停後複蘇的患者，評價其存活出院存活率和神經功能預後(格拉斯哥評分)。
METHODOLOGY
A randomized controlled trial ofpost-resuscitationcardiac arrest patients was conducted from October 2008-September 2014. Patients were randomized to either internal or external cooling methods. Historical controlswere selected matched by age and gender. Analysis using SPSS version 21.0 presented descriptive statistics and frequencies while univariate logistic regression was done using R 3.1.3.
方法：從2008年10月至2014年9月進行了一項針對心髒驟停後複蘇患者的隨機對照試驗。患者被隨機分配為進行體內或外部降溫方法。按年齡和性別進行匹配。采用spss 軟件21.0進行描述數據和頻率，同時應用R 3.1.3進行單變量logistic回歸分析。
RESULTS
23 patients were randomized to internal cooling and 22 patients to external cooling and 42 matched controls were selected. No significant difference was seen between internal and external cooling in terms of survival, neurological outcomes and complications. However in the internal cooling arm, there was lower risk of developing overcooling (p=0.01) and rebound hyperthermia (p=0.02). Compared to normothermia, internal cooling had higher survival (OR=3.36, 95% CI=(1.130, 10.412), and lower risk of developing cardiac arrhythmias (OR=0.18, 95% CI=(0.04, 0.63)). Subgroup analysis showed those with cardiac cause of arrest (OR=4.29, 95% CI=(1.26, 15.80)) and sustained ROSC (OR=5.50, 95% CI=(1.64, 20.39)) had better survival with internal cooling compared to normothermia. Cooling curves showed tighter temperature control for internal compared to external cooling.
結果：23例患者被隨機分配到體內降溫組，22例分配到外部降溫組，42例相匹配的患者為對照組。在體內降溫組和外部降溫組患者的存活率、神經功能預後及並發症均無顯著性差異。然而，體內降溫組有更低的體溫過低和高溫反彈的風險。
與常溫相比，體內降溫組有更高的生存率(OR = 3.36，95 %ci = 1.130 (10.412)，更低的心律失常的風險(OR = 0.18，95 %ci =(0.04, 0.63))。亞組分析顯示，與常溫組比較，那些心源性心髒驟停的患者(OR = 4.29，95 %ci =(1.26, 15.80)) 和持續性ROSC的患者(OR = 5.50，95 %ci =(1.64, 20.39)) 有更好的存活率。降溫曲線表明與外部降溫組相比，體內降溫組有更嚴格的溫度控製。
CONCLUSION
Internal cooling showed tighter temperature control compared to external cooling. Internal cooling can potentially provide better survival-to-hospital discharge outcomes and reduce cardiac arrhythmia complications in carefully selected patients as compared to normothermia.
結論：與外部降溫組相比，體內降溫組有更嚴格的溫度控製。與正常體溫組比較，某些選定的患者中體內降溫可能有更好的出院存活率，並且有更低的心律失常並發症的發生。
翻譯：北京協和醫院研究生 薑輝
