CC：低温和常温目标温度管理在院外急性冠状动脉综合征心脏骤停患者中的比较：一项全国性的回顾性研究

Abstract

Background

Targeted temperature management (TTM) is considered a beneficial treatment for improving outcomes in patients with OHCA due to acute coronary syndrome (ACS). The comparative benefits of hypothermic TTM (32–34°C) versus normothermic TTM (35–36°C) are unclear. This study compares these TTM strategies in improving neurological outcomes and survival rates in OHCA patients with ACS.目标温度管理（TTM）被认为是一种有益的治疗方法，可改善因急性冠状动脉综合征（ACS）导致院外心脏骤停（OHCA）患者的预后。低温TTM（32–34°C）与常温TTM（35–36°C）的疗效对比尚不明确。本研究比较了这两种TTM策略在改善ACS相关OHCA患者神经功能预后和生存率方面的效果。

Methods

We conducted a retrospective analysis using data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest (JAAM-OHCA) registry, encompassing 68,110 OHCA patients between June 2014 and December 2020. After applying inclusion and exclusion criteria, 1,217 adult patients with ACS who received TTM were eligible for the study. Patients were categorized into two groups based on their TTM strategy: hypothermic TTM (32–34°C) and normothermic TTM (35–36°C). The primary outcome was 30-day favorable neurological outcome, defined by the Cerebral Performance Category (CPC) scale (CPC 1–2). Secondary outcomes included 30-day survival and adverse event incidence. Statistical analysis involved multivariable logistic regression and propensity score adjustments with inverse probability weighting (IPW) to account for potential confounders.我们使用日本急救医学会院外心脏骤停（JAAM-OHCA）登记处的数据进行了回顾性分析，涵盖了2014年6月至2020年12月期间的68,110名OHCA患者。在应用纳入和排除标准后，1,217名接受TTM治疗的ACS成年患者符合研究条件。根据TTM策略，患者被分为两组：低温TTM（32–34°C）和常温TTM（35–36°C）。主要结局是30天良好神经功能预后，定义为脑功能分类量表（CPC）评分为1–2级。次要结局包括30天生存率和不良事件发生率。统计分析采用多变量逻辑回归和倾向评分调整，并使用逆概率加权（IPW）来校正潜在的混杂因素。

Results

Of the 1,217 patients, 369 received normothermic TTM and 848 received hypothermic TTM. In both groups, most patients were male, with a median age in the 60s. Approximately 70% had a shockable rhythm at the scene, one-third had a shockable rhythm in-hospital, around 70% had ST segment elevation, and about half received extracorporeal membrane oxygenation. The proportions of patients with 30-day favorable neurological outcomes were 36.6% (135) in the normothermic group and 36.6% (310) in the hypothermic group. No difference in neurological outcomes was observed in the multivariable regression analysis (adjusted OR 1.14, 95% CI 0.84–1.54), and the result was consistent in the IPW analysis (OR 1.11, 95% CI 0.84–1.47). Other outcomes also showed no significant differences.在1,217名患者中，369名接受了常温TTM，848名接受了低温TTM。两组中大多数患者为男性，中位年龄在60多岁。约70%的患者在现场出现可电击心律，三分之一在医院内出现可电击心律，约70%的患者有ST段抬高，约一半的患者接受了体外膜肺氧合治疗。常温组和低温组中30天良好神经功能预后的患者比例均为36.6%（分别为135名和310名）。多变量回归分析未观察到神经功能预后的差异（校正后OR 1.14，95% CI 0.84–1.54），IPW分析结果一致（OR 1.11，95% CI 0.84–1.47）。其他结局也未显示显著差异。

Conclusion

In this nationwide, retrospective study using the JAAM-OHCA registry, we found no significant differences in 30-day favorable neurological outcome, 30-day survival, and adverse event incidences between hypothermic TTM (32–34°C) and normothermic TTM (35–36°C) in adult patients with OHCA due to ACS.在这项基于JAAM-OHCA登记处的全国性回顾性研究中，我们发现对于因ACS导致OHCA的成年患者，低温TTM（32–34°C）与常温TTM（35–36°C）在30天良好神经功能预后、30天生存率和不良事件发生率方面均无显著差异。