对心脏骤停和可电击心律的患者进行低体温治疗与常体温治疗:TTM-2 研究的二次分析

IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE Critical Care Pub Date : 2024-10-15 DOI:10.1186/s13054-024-05119-3
Fabio Silvio Taccone, Alain Cariou, Stefano Zorzi, Hans Friberg, Janus C. Jakobsen, Per Nordberg, Chiara Robba, Jan Belohlavek, Jan Hovdenes, Matthias Haenggi, Anders Åneman, Anders Grejs, Thomas R. Keeble, Filippo Annoni, Paul J. Young, Matt P. Wise, Tobias Cronberg, Gisela Lilja, Niklas Nielsen, Josef Dankiewicz
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引用次数: 0

摘要

本研究旨在评估与常温疗法相比,低体温疗法是否能提高院外心脏骤停(OHCA)患者的存活率并改善功能预后。对一项务实的多中心随机临床试验(TTM-2,NCT02908308)进行了事后分析。在这项分析中,考虑了参与试验的患者子集,这些患者的特征与之前一项随机试验中的患者相似,并随机接受了 33 °C 低体温疗法或正常体温疗法(即目标温度< 37.8 °C)。主要结果是6个月后的存活率;次要结果包括6个月后的良好功能预后,即修改后的Rankin评分为0-3分。此外,还报告了死亡时间和不良事件的发生情况。TTM-2研究共纳入了1891例患者,其中600例(31.7%)纳入了分析,294例在低体温组,306例在常温组。6 个月时,低体温组 294 名患者中有 207 人(70.4%)存活,常温组 306 名患者中有 220 人(71.8%)存活(低体温的相对风险为 0.96;95% 置信区间 [CI],0.81 至 1.15;P = 0.71)。此外,低体温组 294 人中的 198 人(67.3%)和常温组 306 人中的 202 人(66.0%)的功能结果良好(低体温的相对风险为 1.03;95% 置信区间 [CI],0.87 至 1.23;P = 0.79)。与常温组(43/306,14.1%-OR 1.49,95% CI 1.05-2.14;P = 0.026)相比,低体温组(62/294,21.2%)的心律失常发生率明显增加。在这项研究中,33˚C的低体温并没有改善心脏骤停患者的存活率或功能预后,这些患者的特征与之前研究中显示可从低体温中获益的患者相似。
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Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study
The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target < 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also reported. From a total of 1891 included in the TTM-2 study, 600 (31.7%) were included in the analysis, 294 in the hypothermia and 306 in the normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group had survived (relative risk with hypothermia, 0.96; 95% confidence interval [CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294 (67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia group had a favorable functional outcome (relative risk with hypothermia, 1.03; 95% CI, 0.87 to 1.23; P = 0.79). There was a significant increase in the occurrence of arrythmias in the hypothermia group (62/294, 21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026). In this study, hypothermia at 33˚C did not improve survival or functional outcome in a subset of patients with similar cardiac arrest characteristics to patients in whom benefit from hypothermia was shown in prior studies.
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来源期刊
Critical Care
Critical Care 医学-危重病医学
CiteScore
20.60
自引率
3.30%
发文量
348
审稿时长
1.5 months
期刊介绍: Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.
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