亚低温治疗对心搏骤停心肺复苏患者预后影响

Objective To study clinical effect of moderate hypothennia treatment in patients with cardiac arrest survivors and search a practical monitoring way during moderate hypothennia treatment. Method A total of 40 patients of CPR following the restoration of spontaneous circulation were randomly divided into the hypothermia therapy group ( n= 20) and the routine therapy group ( n= 20), the clinical effect on patient followed for three months is evaluated. At the same time regional cerebral oxygen saturation (rSO2) was detected at different times after moderate hypothennia treatment in two groups. Results The recovery rate were higher and the mutilation rate was lower in hypothermia therapy group than that of the routine therapy group. rSO2 obviously increased after 12 hours of hypothermic treatment, and continuing kept stable level after 24 hours of hypothermic treatment, but it was also higher than routine therapy group (P＜0.01). Conclusions Moderate hypothermia can alleviate the metabolic disorder of the brain tissue and improve the prognosis in patients with cardiac arrest survivors. Noninvasire continuously monitoring of rSO2 has important significance for instructing moderate hypothermia treatment in clinic.     

亚低温对心肺复苏后患者神经功能预后的影响

目的:探讨亚低温技术在心肺复苏后对患者神经功能预后的影响。方法:回顾性分析我院2001-03-2008-05急诊抢救室收治的30例心肺复苏患者的临床资料,根据是否采用亚低温技术,患者随机分为两组:常温组与亚低温组,每组各15例。对复苏后患者的平均脑部温度、血氧饱和度(SaO2)、血酸碱值(pH)、平均动脉压(MAP)、意识障碍评分(GCS)等指标进行分析,3个月后对两组病人神经功能预后进行评定。结果:常温组与亚低温组患者复苏时平均脑部温度分为(36.7±1.3)℃和(33.5±1.1)℃(P<0.05),血氧饱和度(SaO2)、血酸碱值(pH)、平均动脉压(MAP)、意识障碍评分(GCS)等基本相近(P>0.05);3个月后两组神经功能转归良好率分别为40%和73%(P<0.05),其中亚低温6h内实施者优于6h后实施者;神经功能缺损评分(nerve functional in-sufficent,NFI)分别18.7±4.3和14.9±3.7(P<0.05),修改后的Barthel指数(modified Barthel index,MBI)分别为69.5±3.6和74.4±4.5(P<0.05)。结论:亚低温技术在心肺复苏后患者的脑复苏中具有显著的神经功能保护作用,可改善心肺复苏后患者的神经功能状况,实施降温越早,对脑复苏越有利。     

亚低温治疗心肺复苏患者的护理

总结亚低温治疗23例心肺复苏后患者的护理经验。本组亚低温治疗采用冬眠合剂＋全身降温毯降温,给予呼吸机辅助呼吸,在22～26℃的室温下自然复温。在亚低温治疗过程中,正确使用亚低温治疗仪,及时调节降温毯的温度;持续监护心电,密切观察患者的体温、意识、瞳孔、心律、呼吸、血压等,针对不同的原发病,观察的侧重点也有所不同;治疗期间常见并发症有肺部感染、心律失常、凝血功能障碍、高血糖、电解质紊乱、冻伤等,应密切观察其先兆症状,并及时采取应对的护理措施。     

亚低温治疗对心肺复苏后心功能不全的影响研究

现代心肺复苏技术在20世纪50年代末60年代初逐步形成,经过几十年的发展,医疗技术水平不断进步。虽然复苏成功率有了明显提高,但心搏骤停患者的存活率并没有显著提高。心搏骤停后患者心、脑、肺、肾等全身各脏器由于缺血缺氧导致不可逆损害,最终导致死亡。其中最严重的即大脑缺血缺氧性损伤。复苏后心功能不全亦是心肺复苏患者恢复自主循环后的常见并发症,约有1/3的患者在心肺复苏自主循环恢复后最终死于心功能不全。     

局部亚低温治疗对心肺复苏后患者外周血白细胞的影响及研究

目的研究局部亚低温治疗对心肺复苏患者的疗效及外周血白细胞、电解质的影响。方法61例心搏骤停的患者,经急诊科或院内复苏后转入ICU,随机分为治疗组和对照组。治疗组患者入ICU后立即给予局部亚低温治疗,2～4h内将鼓膜温度降至32～35℃,共治疗72h。分别于治疗后第1天、第7天对两组患者外周血白细胞、中性粒细胞及血清电解质进行检测,并对患者预后进行评估。结果治疗组与对照组在复苏成功后第1天的外周血白细胞与中性粒细胞差异无统计学意义。第7天两组间差异有统计学意义(P=0．02,P=0．036)。而两组患者电解质间差异无统计学意义,局部亚低温组预后明显优于对照组,死亡率降低21．1%。结论局部亚低温治疗心肺复苏患者同样能保护脑神经功能,提高存活率,降低外周血白细胞及中性粒细胞,同时对血清电解质影响甚小。     

亚低温治疗对心搏骤停后复苏成功患者的疗效分析

目的 探讨亚低温治疗对心搏骤停后心肺复苏术成功患者的疗效.方法 按照组间基线资料匹配原则,将本院2018年5月至2020年5月心搏骤停后心肺复苏术成功的46例患者随机分组,对照组23例予以常规治疗,观察组23例予以亚低温治疗,观察两组血乳酸清除率、脑神经功能及存活率.结果 与对照组相比,复苏成功6h和24h后,观察组患...     

心肺复苏后患者亚低温脑复苏治疗的观察与护理

总结23例心肺复苏后患者亚低温脑复苏治疗的观察与护理，从基础护理、呼吸支持护理、消化系统护理、脱水治疗护理等4个方面介绍了护理措施，并就治疗过程中患者出现的并发症及其相应的治疗护理作了讨论。认为做好心肺复苏后患者亚低温脑复苏的观察与护理对促进患者康复至关重要。     

呼气末二氧化碳动态变化与亚低温治疗的心肺复苏患者神经预后的关系研究

目的:探讨呼气末二氧化碳(ETCO₂)动态变化与接受亚低温治疗(TH)的心肺复苏患者神经预后的关系。方法:回顾性选择2020年1月—2022年1月我院收治的172例接受TH的心肺复苏患者,根据格拉斯哥昏迷量表(GCS)评分分为轻型昏迷组(6～7分,47例)、中型昏迷组(4～5分,79例)和重型昏迷组(≤3分,46例),根据格拉斯哥-匹兹堡脑功能表现分级(CPC)评分分为神经预后良好组(1～2级,62例),神经预后不良组(3～5级,110例)。分别于TH治疗前(T₀)、治疗12 h(T₁)、治疗24 h(T₂)监测ETCO₂,通过多因素logistic回归分析影响TH心肺复苏患者神经预后的因素,受试者工作特征曲线(ROC)分析ETCO₂预测TH心肺复苏患者神经预后的价值。结果:TH治疗后ETCO₂逐渐增加(P<0.01),重型昏迷组T₁、T₂时ETCO₂低于中型昏迷...     

亚低温治疗心肺脑复苏的研究进展

如何提高心搏骤停后的救治成功率,提高复苏成功患者的生活质量一直是急诊医学和危重症医学研究的焦点。本文通过对亚低温治疗的降温技术、降温开始时间、降温速度、目标温度、亚低温治疗的持续时间、复温、并发症的预防等方面进行综述,说明亚低温治疗在急诊脑复苏抢救中的重要作用,为心搏骤停后脑保护提供了一项安全而有效的手段,最终提高患者的存活率和生活质量。     

亚低温对于心搏骤停患者复苏后心脏功能的影响

<正>心搏骤停患者自主循环恢复以后,45%～60%会发生不同程度的心功能障碍并导致严重的血液动力学紊乱,复苏后72h内的死亡多与此有关~([1])。造成心脏功能异常的原因是多方面的,包括造成心搏骤停的原因通常是心肌梗死,心肌梗死会造成室壁运动障碍,心搏骤停后的心肌顿抑,缺血再灌注损伤等等~([2])。目前可以明确改善复苏后心功能的药物和治疗措施不多。亚低温是指将患者的体温降至32～34℃维持12～24h,作为唯一一项可以     

Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms

Aim

Mild therapeutic hypothermia (32-34 °C) improves neurological recovery and reduces the risk of death in comatose survivors of cardiac arrest when the initial rhythm is ventricular fibrillation or pulseless ventricular tachycardia. The aim of the presented study was to investigate the effect of mild therapeutic hypothermia (32-34 °C for 24 h) on neurological outcome and mortality in patients who had been successfully resuscitated from non-ventricular fibrillation cardiac arrest.

Methods

In this retrospective cohort study we included cardiac arrest survivors of 18 years of age or older suffering a witnessed out-of-hospital cardiac arrest with asystole or pulseless electric activity as the first documented rhythm. Data were collected from 1992 to 2009. Main outcome measures were neurological outcome within six month and mortality after six months.

Results

Three hundred and seventy-four patients were analysed. Hypothermia was induced in 135 patients. Patients who were treated with mild therapeutic hypothermia were more likely to have good neurological outcomes in comparison to patients who were not treated with hypothermia with an odds ratio of 1.84 (95% confidence interval: 1.08-3.13). In addition, the rate of mortality was significantly lower in the hypothermia group (odds ratio: 0.56; 95% confidence interval: 0.34-0.93).

Conclusion

Treatment with mild therapeutic hypothermia at a temperature of 32-34 °C for 24 h is associated with improved neurological outcome and a reduced risk of death following out-of-hospital cardiac arrest with non-shockable rhythms.     

Association of serum lactate and survival outcomes in patients undergoing therapeutic hypothermia after cardiac arrest

Introduction

Recent studies have suggested that serum lactate may serve as a marker to predict mortality after resuscitation from cardiac arrest (CA). The relationship between serum lactate and CA outcomes requires further characterization, especially among patients treated with therapeutic hypothermia (TH) and aggressive post-arrest care.

Methods

A retrospective analysis of patients resuscitated from non-traumatic CA at three urban U.S. hospitals was performed using an established internet-based post-arrest registry. Adult (≥18 years) patients resuscitated from CA and receiving TH treatment were included. Logistic regression analysis was used to adjust for potential confounders to survival outcomes. Survival to discharge served as the primary endpoint.

Results

A total of 199 post-CA patients treated with TH between 5/2005 and 11/2011 were included in this analysis. The mean age was 56.9 ± 16.5 years, 85/199 (42.7%) patients were female, and survival to discharge was attained in 84/199 (42.2%). While lower initial post-CA serum lactate levels were not associated with increased survival to discharge, subsequent lactate measurements were significantly associated with outcomes (24-h serum lactate levels in survivors vs. non-survivors, 2.7 ± 0.5 vs. 4.2 ± 0.4 mmol/L, p < 0.01). Multivariable logistic regression confirmed this relationship with survival to discharge (p < 0.01).

Conclusion

Lower serum lactate levels at 12 h and 24 h, but not initially following cardiac arrest, are associated with survival to hospital discharge after resuscitation from CA and TH treatment. Prospective investigation of serum lactate as a potential prognostic tool in CA is needed.     

Therapeutic benefits of mild hypothermia in patients successfully resuscitated from cardiac arrest: A meta-analysis

BACKGROUND:

Good neurological outcome after cardiac arrest (CA) is hard to achieve for clinicians. Experimental and clinical evidence suggests that therapeutic mild hypothermia is beneficial. This study aimed to assess the effectiveness and safety of therapeutic mild hypothermia in patients successfully resuscitated from CA using a meta-analysis.

METHODS:

We searched the MEDLINE (1966 to April 2012), OVID (1980 to April 2012), EMBASE (1980 to April 2012), Chinese bio-medical literature & retrieval system (CBM) (1978 to April 2012), Chinese medical current contents (CMCC) (1995 to April 2012), and Chinese medical academic conference (CMAC) (1994 to April 2012). Studies were included if 1) the study design was a randomized controlled trial (RCT); 2) the study population included patients successfully resuscitated from CA, and received either standard post-resuscitation care with normothermia or mild hypothermia; 3) the study provided data on good neurologic outcome and survival to hospital discharge. Relative risk (RR) and 95% confidence interval (CI) were used to pool the effect.

RESULTS:

The study included four RCTs with a total of 417 patients successfully resuscitated from CA. Compared to standard post-resuscitation care with normothermia, patients in the hypothermia group were more likely to have good neurologic outcome (RR=1.43, 95% CI 1.14–1.80, P=0.002) and were more likely to survive to hospital discharge (RR=1.32, 95% CI 1.08–1.63, P=0.008). There was no significant difference in adverse events between the normothermia and hypothermia groups (P>0.05), nor heterogeneity and publication bias.

CONCLUSION:

Therapeutic mild hypothermia improves neurologic outcome and survival in patients successfully resuscitated from CA.KEY WORDS: Cardiac arrest, Cardiopulmonary resuscitation, Return of spontaneous circulation, Mild hypothermia, Meta-analysis     

Therapeutic hypothermia and vasopressor dependency after cardiac arrest

Objective

Clinical trials of therapeutic hypothermia (TH) after cardiac arrest excluded patients with persistent hemodynamic instability after return of spontaneous circulation (ROSC), and thus equipoise may exist regarding use of TH in these patients. Our objective was to determine if TH is associated with worsening hemodynamic instability among patients who are vasopressor-dependent after ROSC.

Methods

We performed a prospective observational study in vasopressor-dependent post-cardiac arrest patients. Inclusion criteria were age >17, non-trauma cardiac arrest, comatose after ROSC, and persistent vasopressor dependence. The decision to initiate TH (33–34 °C) was made by the treating physician. We measured cumulative vasopressor index (CVI) and mean arterial pressure (MAP) every 15 min during the first 6 h after ROSC. The outcome measures were change in CVI (primary outcome) and MAP (secondary outcome) over time. We graphed median CVI and MAP over time for the treated and not treated cohorts, and used propensity adjusted repeated measures mixed models to test for an association between TH induction and change in CVI or MAP over time.

Results

Seventy-five post-cardiac arrest patients were included (35 treated; 40 not treated). We observed no major differences in CVI or MAP over time between the treated and not treated cohorts. In the mixed models we found no statistically significant association between TH induction and changes in CVI or MAP.

Conclusion

In patients with vasopressor-dependency after cardiac arrest, the induction of hypothermia was not associated with a decrease in mean arterial pressure or increase in vasopressor requirement.     

1例心搏骤停复苏后患者的人工亚低温循证治疗

目的为1例心搏骤停复苏后昏迷患者制定人工亚低温循证治疗方案。方法针对提出的临床问题，检索Medline（1981—2006年）和Cochrane图书馆（2006年第2期）。结果检索发现，关于心搏骤停复苏后人工亚低温治疗RCT3篇和SR1篇，通过分析检索结果、结合临床医生经验及患者实际情况，为患者制定了循证治疗方案，通过6个月随访发现证实，该方案适合患者。结论对心搏骤停复苏后昏迷者，采用人工亚低温治疗可改善患者的预后。     

The association of body mass index with outcomes and targeted temperature management practice in cardiac arrest survivors

Purpose

Obesity is a well-known risk factor in various health conditions. We analyzed the association between obesity and clinical outcomes, and its effect on targeted temperature management (TTM) practice for cardiac arrest survivors by calculating and classifying their body mass indexes (BMIs).

The emergency cardiac arrest response team (eCART): A novel strategy for improving therapeutic hypothermia utilization following out-of-hospital cardiac arrest

BackgroundOut-of hospital cardiac arrest (OHCA) is associated with significant mortality. Therapeutic hypothermia is one of the few interventions that have been shown to increase post-arrest survival as well as enhance neurologic recovery. Despite clinical guidelines recommending the use of therapeutic hypothermia (TH) following cardiac arrest, utilization rates by physicians remain low. We hypothesized that the development of a multi-disciplinary emergency cardiac arrest response team (eCART) would enhance therapeutic hypothermia utilization in the emergency department for OHCA.Methods and resultsAn eCART (emergency department cardiac arrest response team) was created at a single site academic urban emergency department. The eCART team consisted of a physician hypothermia consultant, a cardiologist, a clinical pharmacist, a respiratory therapist and a chaplain. These providers were notified by page prior to the arrival of an OHCA patient and responded to the ED in person or by phone to support the resuscitation. Analysis of pre- and post-intervention data demonstrated a significant increase in the rate of TH utilization (64% to 96%). There was a non-significant decrease in the time to target temperature.ConclusionsThe creation of a coordinated, multi-disciplinary care team, providing real-time support for OHCA patients increased TH utilization in an emergency department.     

The beneficial effect of mild therapeutic hypothermia depends on the time of complete circulatory standstill in patients with cardiac arrest

Aim

Mild therapeutic hypothermia has shown to improve long-time survival as well as favorable functional outcome after cardiac arrest. Animal models suggest that ischemic durations beyond 8 min results in progressively worse neurologic deficits. Based on these considerations, it would be obvious that cardiac arrest survivors would benefit most from mild therapeutic hypothermia if they have reached a complete circulatory standstill of more than 8 min.

Methods

In this retrospective cohort study we included cardiac arrest survivors of 18 years of age or older suffering a witnessed out-of-hospital cardiac arrest, which remain comatose after restoration of spontaneous circulation. Data were collected from 1992 to 2010. We investigated the interaction of ‘no-flow’ time on the association between post arrest mild therapeutic hypothermia and good neurological outcome. ‘No-flow’ time was categorized into time quartiles (0, 1–2, 3–8, >8 min).

Results

One thousand-two-hundred patients were analyzed. Hypothermia was induced in 598 patients. In spite of showing a statistically significant improvement in favorable neurologic outcome in all patients treated with mild therapeutic hypothermia (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.14–1.93) this effect varies with ‘no-flow’ time. The effect is significant in patients with ‘no-flow’ times of more than 2 min (OR: 2.72; CI: 1.35–5.48) with the maximum benefit in those with ‘no-flow’ times beyond 8 min (OR: 6.15; CI: 2.23–16.99).

Conclusion

The beneficial effect of mild therapeutic hypothermia increases with cumulative time of complete circulatory standstill in patients with witnessed out-of-hospital cardiac arrest.     

Outcomes of patients with trauma and intraoperative cardiac arrest

Background

Although the occurrence of intraoperative cardiac arrest is rare, it is a severe adverse event with a high mortality rate. Trauma patients have additional causes for intraoperative arrest, and we hypothesised that the survival of trauma patients who experienced intraoperative cardiac arrest would be worse than nontrauma patients who experienced intraoperative cardiac arrest.

Objectives

The aim of the present study was to compare the outcomes of trauma and nontrauma patients after intraoperative cardiac arrest.

Methods

In a tertiary university hospital and trauma centre, the intraoperative cardiac arrest cases were evaluated from January 2007 to December 2009, excluding patients submitted to cardiac surgery. Data were prospectively collected using the Utstein-style. Outcomes among the patients with trauma were compared to the patients without trauma.

Results

We collected data from 81 consecutive intraoperative cardiac arrest cases: 32 with trauma and 49 without trauma. Patients in the trauma group were younger than the patients in the nontrauma group (44 ± 23 vs. 63 ± 17, p < 0.001). Hypovolaemia (63% vs. 35%, p = 0.022) and metabolic/hydroelectrolytic disturbances (41% vs. 2%, p < 0.001) were more likely to cause the cardiac arrest in the trauma group. The first documented arrest rhythm did not differ between the groups, and pulseless electrical activity was the most prevalent rhythm (66% vs. 53%, p = 0.698). The return of spontaneous circulation (47% vs. 63%, p = 0.146) and survival to discharge with favourable neurological outcome (16% vs. 14%, p = 0.869) did not differ between the two groups.

Conclusions

The outcomes did not differ between patients with trauma and nontrauma intraoperative cardiac arrest.