心停止後の低体温症は,ショックを受けられる患者と,ショックを受けない患者の両方に有効ですか? :大規模なレジストリからの洞察
Florence Dumas1, David Grimaldi, Benjamin Zuber
1Service de Réanimation Médicale, Hôpital Cochin, Paris, France.
Circulation
|February 16, 2011
まとめ
治療的な軽度の低体温症は,心拍不全患者 (VF/VT) のアウトカムを改善する. しかし,低体温症は,非ショックリズム (PEA/asystole) の患者にとって有意な利点を示さない.
科学分野:
- 心臓病学 心臓病学
- 緊急医療 緊急医療
- 神経学 神経学とは
背景:
- 治療的な軽度の低体温症 (TMH) の証拠は,ショック性心停止リズム (心室細動/無脈動心室性短心症 [VF/VT]) に対して強力です.
- TMHの有効性は,非ショック可能なリズム (パルスレス電気活動/アシストール [PEA/アシストール]) に対して,より明確ではありません.
研究 の 目的:
- 発症時の神経学的結果に対する低体温症の予後値を,心停止患者の大群における初期心拍数に基づいて評価する.
主な方法:
- 病院外心停止患者1145人 (2000年−2009年) の将来的なデータ収集で,蘇生が成功しました.
- TMHと良好な神経学的結果 (脳性能カテゴリー1または2) の関連性を定量化するためのロジスティック回帰分析.
主要な成果:
- TMHはVF/VT患者の65%,PEA/asystole患者の60%に投与されました.
- 全体として,患者の30%が好ましい神経学的結果を達成しました.
- TMHはVF/VT患者の神経学的アウトカム改善と関連していた (aOR 1.90) が,PEA/asystole患者ではそうではなかった (aOR 0.71).
結論:
- 低体温は,VF/VTの心停止患者で病院退院の改善と独立して関連しています.
- TMHは,非ショックリズム (PEA/asystole) の患者で良好な結果と有意な関連性を示しませんでした.
- PEA/asystole患者におけるTMHの有効性の欠如を理解するためにさらなる研究が必要である.
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