New England Journal of Medicine· 2019Q1
Şoklanamayan Ritimli Kardiyak Arrest İçin Hedeflenen Sıcaklık Yönetimi
Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
- 658atıf
- Q1SCImago
- 2019yıl
Kısa özet
Şoklanamayan ritimle kardiyak arrestten kurtarılan komatöz hastalarda, hedeflenen normotermiye (37°C) kıyasla orta derecede terapötik hipotermi (33°C) 24 saat boyunca, %4,5'lik bir farkla (%10,2'ye karşılık %5,7) olumlu nörolojik sonuçları iyileştirdi.
Yapay zekâ ile başlık ve abstract'tan üretildi; tam metin okunmaz.
Ana noktalar
- Orta derecede hipotermi (33°C), şoklanamayan ritimli komatöz kardiyak arrest hastalarında olumlu nörolojik sonuçları %4,5 oranında iyileştirdi.
- 90. günde, hipotermi grubundaki hastaların %10,2'si (CPC skoru 1-2) olumlu nörolojik sonuca sahipken, normotermi grubunda bu oran %5,7 idi.
- 90 günlük mortalite oranları hipotermi (%81,3) ve normotermi (%83,2) grupları arasında anlamlı farklılık göstermedi.
- Önceden belirlenmiş yan etkilerin görülme sıklığı iki sıcaklık yönetimi stratejisi arasında anlamlı farklılık göstermedi.
Yapay zekâ ile başlık ve abstract'tan üretildi; tam metin okunmaz.
Özet (abstract)
BACKGROUND: Moderate therapeutic hypothermia is currently recommended to improve neurologic outcomes in adults with persistent coma after resuscitated out-of-hospital cardiac arrest. However, the effectiveness of moderate therapeutic hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) is debated. METHODS: We performed an open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in patients with coma who had been admitted to the intensive care unit (ICU) after resuscitation from cardiac arrest with nonshockable rhythm. The primary outcome was survival with a favorable neurologic outcome, assessed on day 90 after randomization with the use of the Cerebral Performance Category (CPC) scale (which ranges from 1 to 5, with higher scores indicating greater disability). We defined a favorable neurologic outcome as a CPC score of 1 or 2. Outcome assessment was blinded. Mortality and safety were also assessed. RESULTS: From January 2014 through January 2018, a total of 584 patients from 25 ICUs underwent randomization, and 581 were included in the analysis (3 patients withdrew consent). On day 90, a total of 29 of 284 patients (10.2%) in the hypothermia group were alive with a CPC score of 1 or 2, as compared with 17 of 297 (5.7%) in the normothermia group (difference, 4.5 percentage points; 95% confidence interval [CI], 0.1 to 8.9; P = 0.04). Mortality at 90 days did not differ significantly between the hypothermia group and the normothermia group (81.3% and 83.2%, respectively; difference, -1.9 percentage points; 95% CI, -8.0 to 4.3). The incidence of prespecified adverse events did not differ significantly between groups. CONCLUSIONS: Among patients with coma who had been resuscitated from cardiac arrest with nonshockable rhythm, moderate therapeutic hypothermia at 33°C for 24 hours led to a higher percentage of patients who survived with a favorable neurologic outcome at day 90 than was observed with targeted normothermia. (Funded by the French Ministry of Health and others; HYPERION ClinicalTrials.gov number, NCT01994772.).
Yazarların özeti; kaynağından alınmıştır. New England Journal of Medicine, 2019 · DOI ↗
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