每日一题_2022.07.20

A 53-year-old woman collapses on the street, witnessed by bystanders, who initiate cardiopulmonary resuscitation and call emergency medical services (EMS). When EMS arrive, they find her to be in ventricular fibrillation and resuscitate her with chest compressions, epinephrine, and defibrillation. On arrival in the emergency department, she is intubated for airway protection, given her depressed mental status, and remains hemodynamically stable. Her ECG shows diffuse ST depressions.

Which of the following interventions is most likely to improve her neurologic outcome?

A. Amiodarone, 150 mg bolus, followed by 1 mg/min for 8 hours, then 0.5 mg/min for 16 hours

B. Active temperature control to a target temperature of 33-36°C (91.4-96.8°F) for at least 24 hours

C. Lung-protective ventilation strategy (including tidal volume 4-8 mL/kg of ideal body weight)

D. Immediate cardiac catheterization for revascularization

答案解析：

胺碘酮可用于治疗或预防与心脏骤停相关的室性心律失常，但尚未显示可改善心脏骤停后神经功能完整的生存率。

在两项随机试验中，与无温度控制相比，靶向温度管理已被证明可提供显著的神经功能完整生存获益。随后的试验没有证明33°C(91.4°F) 与36°C(96.8°F) 的主动管理之间存在差异，目前仍不清楚一些患者是否从不同的特定目标中获益。

虽然肺保护策略通常被认为是良好实践，并且心脏骤停后患者的肺损伤风险增加，但尚未确定关于神经功能完整生存的获益。

虽然原发性室性心律失常患者的文献基础支持立即进行心导管插入术，但神经完整生存的已确定获益不如靶向温度管理明确。

正确答案：B