ICM:血管内降温与体表降温在院外心脏骤停患者到达医院后接受低温治疗中的比较

Abstract

Purpose: To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA).比较在院外心脏骤停（OHCA）患者到达医院后接受目标温度管理（TTM），将体温控制在 33℃时，使用血管内（IC）降温设备与体表降温（SFC）设备的效能。

Methods: A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature < 33.5 °C within 4 h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0-3 at 6 months, analyzed using Inverse Probability Treatment Weighting (IPTW).这是一项事后分析，纳入了 TTM2 试验（NCT02908308）中随机接受低温治疗的 OHCA 患者，该试验对比了低温治疗与常温治疗。主要结局指标为降温效能，定义为在 4 小时内达到目标温度（< 33.5℃）的患者比例、维持阶段体温超出目标范围的时间、复温速率以及 TTM 后发热情况。探索性结局指标包括生存情况和良好的功能结局（定义为 6 个月时改良 Rankin 量表（mRS）评分为 0 – 3 分），采用逆概率处理加权法（IPTW）进行分析。

Results: Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4 h was higher with IC (IC: 69.6% vs. SFC: 49.2%; p < 0.001). Temperature outside ranges during the cooling period and post-TTM fever were lower with IC compared to SFC (17.2% vs. 39.6%; p < 0.001 and 0% vs. 6.3%; p < 0.001, respectively). In the exploratory IPTW analysis, 6-month survival rates were 55.2% in the IC group and 50.2% in the SFC group (OR 1.22, 95% CI 0.89-1.68) and survival with good functional outcome at 6 months was 51.1% patients in the IC group and 44.9% in the SFC (OR 1.28, 95% CI 0.93-1.77).在随机接受低温治疗的 930 名患者中，有 876 名使用了降温设备并纳入本研究。其中，27.3% 的患者使用 IC 设备，72.7% 的患者使用 SFC 设备。IC 组在 4 小时内达到目标温度的患者比例高于 SFC 组（IC 组：69.6%；SFC 组：49.2%；P < 0.001）。与 SFC 组相比，IC 组在降温阶段和 TTM 后体温超出目标范围的比例更低（分别为 17.2% 对 39.6%，P < 0.001；以及 0% 对 6.3%，P < 0.001），且 TTM 后未出现发热情况。在探索性 IPTW 分析中，IC 组 6 个月的生存率为 55.2%，SFC 组为 50.2%（比值比 OR 为 1.22，95% 置信区间 CI 为 0.89 – 1.68）；IC 组 6 个月时具有良好功能结局的生存率为 51.1%，SFC 组为 44.9%（OR 为 1.28，95% CI 为 0.93 – 1.77）。

Conclusions: Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.在 TTM2 研究中随机接受低温治疗的 OHCA 患者中，与体表降温相比，血管内降温具有更好的降温效能。