低溫療法與到院前心臟停止後續結果的相關性：台灣鄉村地區的回顧性世代研究

Abstract

背景：低溫療法對於在院前心臟停止後仍然昏迷狀態的病人，是個復甦後照顧指引，有助於存活出院及後續神經學預後改善，近年有其他研究及顯示指出，低溫治療對預後可能不如預期，論文目標是探討台灣鄉村地區院外心臟停止病人和低溫治療，和其預後關聯。 方法：此論文回顧性世代研究收集2014年至2021年八年期間到院前心臟停止經急救成功昏迷病人共167位，依據後續是否接受低溫療法，分成低溫治療組及非低溫治療組，探討二項結果，存活出院及存活出院合併較佳神經預後，其中神經預後是以大腦功能量表來評分，1-2分代表較佳神經學預後，干擾因子會納入性別，年齡，過去病史，到院前因子如旁觀者目擊倒下，旁觀者心肺復甦術，救護員心肺復甦術，到院前電擊，運送方式，急診首次監測心律，急救過程，心導管治療等，以羅吉斯迴歸及分層分析統計。 結果：在167位到院前心臟停止病人中，低溫治療組（42人），年齡平均為66.5歲，標準差為13.1?，男性比例為59.5%，而非低溫治療組（125人），年齡平均為69.9歲，標準差為15.4?，男性比例為56.8%，以存活出院結果評定，在低溫治療組中有存活出院病人11人(26.2%）在非低溫治療組有16人(12.9%），低溫治療組經多變項調整後勝算比(95% 信賴區間)為2.21 (0.84~5.85)。以存活出院合併較佳神經學預後結果評定，在低溫治療組中有存活出院病人4人(9.5%）在非低溫治療組有4人(3.2%），低溫治療組經多變項調整後勝算比(95% 信賴區間)為4.01 (0.74~21.78)，在分層分析年齡小於65?組別，以存活出院預後結果評定，低溫治療組經多變項調整後勝算比(95% 信賴區間)為7.39 (1.30~41.91)。 結論：低溫治療對於到院前到院前心臟停止經急診成功無恢復意識病人，在其存活出院率及存活出院合併較佳神經學預後上，有正向作用雖然無統計意義；到院前旁觀者目擊倒下，心肺復甦術及電擊，救護車早期監控也對於其存活出院，有其重要性尤其在鄉村地區。

Background: Therapeutic hypothermia management (TH) is a recommended therapy for patients with cardiac arrest to improve hospital survival and achieve favorable neurologic outcomes. Recent research on therapeutic hypothermia management of out-of-hospital cardiac arrest (OHCA) patients has revealed mixed results. We aim to investigate the association between TH management and the outcomes for OHCA patients in Taiwan rural areas. Methods: In this retrospective cohort study, we analyzed 167 OHCA comatose patients after resuscitation with a return of spontaneous circulation to undergo TH management between January 2014 and December 2021. The primary outcome was hospital discharge survival. Secondary outcomes included hospital discharge survival with a favorable neurologic outcome, assessed with 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. Results: Among 167 patients, 42 patients were TH group (mean [standard deviation] age, 66.5 [13.1] years; men, 59.5%),, and 125 patients were non-TH group (mean [standard deviation] age, 69.9 [15.4] years; men, 56.8%).. Under the assessment of hospital discharge survival, 11 survival patients (26.2%) were in the TH group, as compared with 16 survival patients (12.9%) in the non-TH group [odds ratio (OR) with TH, 2.21; 95% confidence interval (CI):0.84~5.85]. Under the assessment of hospital discharge survival with a favorable neurologic outcome, 4 patients (9.5%) with a mild or better disability were in the TH group, as compared with 4 patients in the non-TH group [OR with TH: 4.01; 95% CI:0.74~21.78]. In the subgroup analysis of group (<65 years-old), under the assessment of hospital discharge survival, the odds ratio in the TH group was 7.39 (95%CI:1.30~41.91) as compared with the non-TH group. Conclusion: In patients with coma after out-of-hospital cardiac arrest in a rural area, therapeutic hypothermia management would probably improve hospital discharge survival rate and hospital discharge survival rate with better neurologic outcomes even without statistical significance. Factors such as pre-hospital bystander witness arrest, early cardiopulmonary resuscitation, early defibrillation, and ambulance monitoring are essential, especially in rural areas.