Guang-Qi Guo, Yan-Nan Ma, Shuang Xu, Hong-Rong Zhang, Peng Sun
{"title":"对心脏骤停患者进行针对性体温管理后复温发热的效果:系统回顾和荟萃分析。","authors":"Guang-Qi Guo, Yan-Nan Ma, Shuang Xu, Hong-Rong Zhang, Peng Sun","doi":"10.5847/wjem.j.1920-8642.2023.056","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between post-rewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the influence of PRF on patients with CA.</p><p><strong>Methods: </strong>EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random effects model or fixed effects model to calculate the pooled odds ratios (<i>ORs</i>) and corresponding 95% confidence intervals (<i>CI</i> s). The outcome data were unfavorable neurological outcome and mortality.</p><p><strong>Results: </strong>The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no effect on the neurological outcome of CA patients (<i>OR</i> 0.71, 95% <i>CI</i> 0.43-1.17, <i>I</i> <sup>2</sup> 82%) and has a significant relationship with lower mortality (<i>OR</i> 0.63; 95% <i>CI</i> 0.49-0.80, <i>I</i> <sup>2</sup> 39%). However, PRF with a stricter definition (body temperature >38.5 °C ) was associated with worse neurological outcome (<i>OR</i> 1.44, 95% <i>CI</i> 1.08-1.92, <i>I</i> <sup>2</sup> 45%) and higher mortality (<i>OR</i> 1.71, 95% <i>CI</i> 1.25-2.35, <i>I</i> <sup>2</sup> 47%).</p><p><strong>Conclusion: </strong>This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. However, PRF >38.5 °C is a potential prognostic factor for worse outcomes in CA patients.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10156532/pdf/WJEM-14-217.pdf","citationCount":"0","resultStr":"{\"title\":\"Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis.\",\"authors\":\"Guang-Qi Guo, Yan-Nan Ma, Shuang Xu, Hong-Rong Zhang, Peng Sun\",\"doi\":\"10.5847/wjem.j.1920-8642.2023.056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between post-rewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the influence of PRF on patients with CA.</p><p><strong>Methods: </strong>EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random effects model or fixed effects model to calculate the pooled odds ratios (<i>ORs</i>) and corresponding 95% confidence intervals (<i>CI</i> s). The outcome data were unfavorable neurological outcome and mortality.</p><p><strong>Results: </strong>The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no effect on the neurological outcome of CA patients (<i>OR</i> 0.71, 95% <i>CI</i> 0.43-1.17, <i>I</i> <sup>2</sup> 82%) and has a significant relationship with lower mortality (<i>OR</i> 0.63; 95% <i>CI</i> 0.49-0.80, <i>I</i> <sup>2</sup> 39%). However, PRF with a stricter definition (body temperature >38.5 °C ) was associated with worse neurological outcome (<i>OR</i> 1.44, 95% <i>CI</i> 1.08-1.92, <i>I</i> <sup>2</sup> 45%) and higher mortality (<i>OR</i> 1.71, 95% <i>CI</i> 1.25-2.35, <i>I</i> <sup>2</sup> 47%).</p><p><strong>Conclusion: </strong>This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. 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引用次数: 0
摘要
背景:目标温度管理(TTM)作为心脏骤停(CA)的治疗性温度控制策略,被指南推荐。然而,复温后发热(PRF)与CA患者预后的关系尚不清楚。因此,我们的目的是总结有关PRF对ca患者影响的研究。方法:检索EMBASE、PubMed和Cochrane Central数据库,从建立到2022年3月13日。纳入了CA患者PRF的随机临床试验(rct)和队列研究。根据异质性,采用随机效应模型或固定效应模型进行meta分析,计算合并优势比(ORs)和相应的95%置信区间(CI)。结果数据为不利的神经转归和死亡率。结果:荟萃分析包括11项观察性研究,涉及3246例患者。meta分析结果显示,PRF(体温>38.0°C)对CA患者的神经预后无影响(OR 0.71, 95% CI 0.43-1.17, i2 82%),与较低的死亡率有显著关系(OR 0.63;95% ci 0.49-0.80, i2 39%)。然而,严格定义的PRF(体温>38.5°C)与较差的神经预后(OR 1.44, 95% CI 1.08-1.92, i245%)和较高的死亡率(OR 1.71, 95% CI 1.25-2.35, i247%)相关。结论:本研究提示,完成TTM的CA患者,PRF >38.0°C可能不会影响神经预后,且死亡率较低。然而,PRF >38.5°C是CA患者预后较差的潜在预后因素。
Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis.
Background: Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between post-rewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the influence of PRF on patients with CA.
Methods: EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random effects model or fixed effects model to calculate the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CI s). The outcome data were unfavorable neurological outcome and mortality.
Results: The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no effect on the neurological outcome of CA patients (OR 0.71, 95% CI 0.43-1.17, I2 82%) and has a significant relationship with lower mortality (OR 0.63; 95% CI 0.49-0.80, I2 39%). However, PRF with a stricter definition (body temperature >38.5 °C ) was associated with worse neurological outcome (OR 1.44, 95% CI 1.08-1.92, I2 45%) and higher mortality (OR 1.71, 95% CI 1.25-2.35, I2 47%).
Conclusion: This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. However, PRF >38.5 °C is a potential prognostic factor for worse outcomes in CA patients.
期刊介绍:
The journal will cover technical, clinical and bioengineering studies related to multidisciplinary specialties of emergency medicine, such as cardiopulmonary resuscitation, acute injury, out-of-hospital emergency medical service, intensive care, injury and disease prevention, disaster management, healthy policy and ethics, toxicology, and sudden illness, including cardiology, internal medicine, anesthesiology, orthopedics, and trauma care, and more. The journal also features basic science, special reports, case reports, board review questions, and more. Editorials and communications to the editor explore controversial issues and encourage further discussion by physicians dealing with emergency medicine.