医学
自然循环恢复
心肺复苏术
体温过低
荟萃分析
随机对照试验
麻醉
复苏
内科学
作者
Filippo Annoni,Lorenzo Peluso,Marco Fiore,Per Nordberg,Leif Svensson,Benjamin S. Abella,Lorenzo Calabrò,Sabino Scolletta,Jean Louis Vincent,Jacques Creteur,Fabio Silvio Taccone
出处
期刊:Resuscitation
[Elsevier]
日期:2021-02-02
卷期号:162: 365-371
被引量:6
标识
DOI:10.1016/j.resuscitation.2021.01.029
摘要
Abstract
Background
Therapeutic cooling initiated during cardiopulmonary resuscitation (intra arrest therapeutic hypothermia, IATH) provided diverging effect on neurological outcome of out-of-hospital cardiac arrest (OHCA) patients depending on the initial cardiac rhythm and the cooling methods used. Methods
We performed a systematic search of PubMed, EMBASE and the CENTRAL databases using established Medical Subject Headings (MeSH) terms for IATH and OHCA. Only studies comparing IATH to standard in-hospital targeted temperature management (TTM) were selected. We used the revised Cochrane RoB-2 and the Newcastle–Ottawa scale tool to assess risk of bias of each study. Primary outcome was favorable neurological outcome (FO); secondary outcomes included return of spontaneous circulation (ROSC) rate and survival to hospital discharge. Results
Out of 20,950 studies, 8 studies (n = 3493 patients, including 4 randomized trials, RCTs) were included in the final analysis. Compared to controls, the use of IATH was not associated with improved FO (OR 0.96 [95% CIs 0.68–1.37]; p = 0.84), increased ROSC rate (OR 1.11 [95% CIs 0.83–1.49]; p = 0.46) or survival (OR 0.91 [95% CIs 0.73–1.14]; p = 0.43). Significant heterogeneity among studies was observed for the analysis of ROSC rate (I2 = 69%). Trans-nasal evaporative cooling and cold fluids were explored in two RCTs each and no differences were observed on FO, event when only patients with an initial shockable rhythm were analyzed (OR 1.62 [95% CI 1.00–2.64]; p = 0.05]. Conclusions
In this meta-analysis, IATH was not associated with improved neurological outcome when compared to standard in-hospital TTM, based on very low certainty of evidence. Clinical Trial Registration
PROSPERO (CRD42019130322).
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