An observational study of surface versus endovascular cooling techniques in cardiac arrest patients: a propensity-matched analysis

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• 作者：Sang Hoon Oh (1)
  Joo Suk Oh (1)
  Young-Min Kim (1)
  Kyu Nam Park (1)
  Seung Pill Choi (1)
  Gi Woon Kim (2)
  Kyung Woon Jeung (3)
  Tae Chang Jang (4)
  Yoo Seok Park (5)
  Yeon Young Kyong (1)
  On behalf of the Korean Hypothermia Network Investigators
  
  1. Department of Emergency Medicine ; College of Medicine ; The Catholic University of Korea ; 222 ; Banpodaero ; Seocho-gu ; Seoul ; Korea ; 137-701
  2. Department of Emergency Medicine ; College of Medicine ; Ajou University ; 164 ; World cup-ro ; Yeongtong-gu ; Suwon-si ; Gyeonggi-do ; Korea ; 443-380
  3. Department of Emergency Medicine ; College of Medicine ; Chonnam National University ; 42 ; Jebong-ro ; Dong-gu ; Gwangju ; South Korea ; 501-757
  4. Department of Emergency Medicine ; College of Medicine ; Catholic University of Daegu ; 33 ; Duryugongwonro 17-gil ; Nam-gu ; Daegu ; Korea ; 705-718
  5. Department of Emergency Medicine ; College of Medicine ; Yonsei University ; 50-1 ; Yonsei-ro ; Seodaemun-gu ; Seoul ; Korea ; 120-752
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：695 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Various methods and devices have been described for cooling after cardiac arrest, but the ideal cooling method remains unclear. The aim of this study was to compare the neurological outcomes, efficacies and adverse events of surface and endovascular cooling techniques in cardiac arrest patients. Methods We performed a multicenter, retrospective, registry-based study of adult cardiac arrest patients treated with therapeutic hypothermia presenting to 24 hospitals across South Korea from 2007 to 2012. We included patients who received therapeutic hypothermia using overall surface or endovascular cooling devices and compared the neurological outcomes, efficacies and adverse events of both cooling techniques. To adjust for differences in the baseline characteristics of each cooling method, we performed one-to-one matching by the propensity score. Results In total, 803 patients were included in the analysis. Of these patients, 559 underwent surface cooling, and the remaining 244 patients underwent endovascular cooling. In the unmatched cohort, a greater number of adverse events occurred in the surface cooling group. Surface cooling was significantly associated with a poor neurological outcome (cerebral performance category 3鈥?) at hospital discharge (p鈥?鈥?.01). After propensity score matching, surface cooling was not associated with poor neurological outcome and hospital mortality [odds ratio (OR): 1.26, 95% confidence interval (CI): 0.81-1.96, p鈥?鈥?.31 and OR: 0.85, 95% CI: 0.55-1.30, p鈥?鈥?.44, respectively]. Although surface cooling was associated with an increased incidence of adverse events (such as overcooling, rebound hyperthermia, rewarming related hypoglycemia and hypotension) compared with endovascular cooling, these complications were not associated with surface cooling using hydrogel pads. Conclusions In the overall matched cohort, no significant difference in neurological outcomes and hospital morality was observed between the surface and endovascular cooling methods.