[Influence of therapeutic temperature management on the clinical course in patients after in-hospital cardiac arrest : A retrospective analysis]
- PMID: 33877423
- DOI: 10.1007/s00063-021-00814-3
[Influence of therapeutic temperature management on the clinical course in patients after in-hospital cardiac arrest : A retrospective analysis]
Abstract
Methods: Retrospective analysis of all patients with in-hospital cardiac arrest and return of spontaneous circulation (ROSC) in the ICU of the cardiologic department of the University Hospital of Halle (Saale) between 1999 and 2009.
Results: During the observation period, 169 patients with in-hospital cardiac arrest and information regarding temperature measurements were treated. Invasive therapeutic temperature management (TTM+) was applied in 64 patients (37.9%), while 105 patients (62.1%) underwent no therapeutic temperature management (TTM-). TTM+ and TTM- showed no relevant differences regarding patient age (TTM+: 67.6 ± 12.6 years; TTM-: 69.8 ± 12.6 years; p = 0.257), comorbidities and the initial rhythm; however, there were more men in the TTM+ group (76.6% vs. 58.1%; p = 0.015). All patients had been intubated. Time until ROSC in TTM+ was significantly longer (25.9 ± 25.8 min vs. 15.0 ± 12.4 min; p < 0.005). TTM+ resulted in a lower 30-day survival and an unfavourable neurologic outcome (Glasgow outcome scale I or II: 75% TTM+ vs. 55.2% TTM-). This negative effect persisted after adjustment for age of the patients, but not after adjustment for age and duration of reanimation (nonadjusted odds ratio for adverse neurologic outcome under TTM+: 0.411 (p = 0.011); odds ratio after adjusting for age: 0.361 (p = 0.09); odds ratio after adjusting for age and duration of the reanimation: 0.505 (p = 0.121)).
Zusammenfassung: METHODE: Retrospektive Analyse von allen Patienten nach stattgehabtem intrahospitalem Herz-Kreislauf-Stillstand und Wiedererlangung eines Spontankreislaufs, die auf der Intensivstation der kardiologischen Abteilung des Universitätsklinikums Halle (Saale) im Zeitraum von 1999–2009 behandelt werden.
Ergebnisse: Im Untersuchungszeitraum werden insgesamt 169 Patienten (62,4 %) mit Angaben zur Körpertemperatur über mehr als 8 h behandelt. Bei 64 Patienten (37,9 %) wird ein invasives therapeutisches Temperaturmanagement (targeted temperature management – TTM+) durchgeführt, bei 105 Patienten (62,1 %) erfolgt dies nicht (TTM−). Die beiden Gruppen zeigen hinsichtlich des Alters (TTM+: 67,6 ± 12,6 Jahre, TTM−: 69,8 ± 12,6 Jahre; p = 0,257), der Komorbiditäten und des Ereignis-EKGs keine signifikanten Unterschiede, allerdings ist der Anteil männlicher Patienten in der Gruppe TTM+ signifikant größer (76,6 % vs. 58,1 %; p = 0,015). Alle Patienten sind nach der Reanimation intubiert und beatmet. Die Zeit bis zum Wiederkehr eines Spontankreislaufs (ROSC) ist in der Gruppe der TTM(+)-Patienten erhöht (25,9 ± 25,8 min vs. 15,0 ± 12,4 min; p = 0,005). In der Gruppe TTM+ zeigen sich ein geringeres 30-Tage-Überleben sowie ein ungünstigeres neurologisches Ergebnis im Vergleich zur Gruppe TTM− (Glasgow Outcome Scale I oder II: 75 % vs. 55,2 %). Der negative Einfluss der Hypothermie bleibt nach Adjustierung für das Alter der Patienten bestehen, nicht jedoch nach Adjustierung sowohl für das Alter als auch für die Dauer der Reanimation (nichtadjustierte Odds-Ratio für günstiges neurologisches Ergebnis unter TTM: 0,411 [p = 0,011]; Odds-Ratio bei Adjustierung für das Alter: 0,396 [p = 0,009]; Odds-Ratio nach Adjustierung für Alter und Dauer der Reanimation: 0,505 [p = 0,121]).
Keywords: Body temperature; Heart arrest; Hypothermia; Return of spontaneous circulation; Treatment outcome.
© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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