心肺复苏后体温管理研究进展
Research Progress of Target Temperature Management after Cardiopulmonary Resuscitation
DOI: 10.12677/ACM.2023.131106, PDF,   
作者: 郭光奇*, 孙 鹏#:华中科技大学同济医学院附属协和医院,湖北 武汉
关键词: 心搏骤停低温治疗目标温度管理Cardiac Arrest Therapeutic Hypothermia Target Temperature Management
摘要: 低温治疗是国际心肺复苏指南中推荐的可以改善心搏骤停患者神经功能预后的重要治疗措施。但是随着研究的进展,目前关于低温治疗有效性的争论越来越多。本综述中,我们主要阐述了目前关于低温治疗临床实践中的争议,并评估其在临床中作为自主循环恢复后保护神经功能的作用。
Abstract: Therapeutic hypothermia is an important clinical intervention and recommended by international cardiopulmonary resuscitation guidelines to improve the neurological function in patients with cardiac arrest. However, emerged researches in recent years contributed a controversial conclusion about therapeutic hypothermia. In this review, we focus on the current controversies surrounding therapeutic hypothermia. Meanwhile, we evaluate the neurological function preservation of thera-peutic hypothermia after the return of spontaneous circulation in cardiac arrest patients.
文章引用:郭光奇, 孙鹏. 心肺复苏后体温管理研究进展[J]. 临床医学进展, 2023, 13(1): 729-736. https://doi.org/10.12677/ACM.2023.131106

参考文献

[1] Myat, A., Song, K.J. and Rea, T. (2018) Out-of-Hospital Cardiac Arrest: Current Concepts. Lancet (London, England), 391, 970-979. [Google Scholar] [CrossRef
[2] Andersen, L.W., Holmberg, M.J., Berg, K.M., Donnino, M.W. and Granfeldt, A. (2019) In-Hospital Cardiac Arrest: A Review. JAMA, 321, 1200-1210. [Google Scholar] [CrossRef] [PubMed]
[3] Henson, T., Rawanduzy, C., Salazar, M., Sebastian, A., Weber, H., Al-Mufti, F. and Mayer, S.A. (2022) Outcome and Prognostication after Cardiac Arrest. Annals of the New York Acade-my of Sciences, 1508, 23-34. [Google Scholar] [CrossRef] [PubMed]
[4] Sandroni, C., Cronberg, T. and Sekhon, M. (2021) Brain Injury after Car-diac Arrest: Pathophysiology, Treatment, and Prognosis. Intensive Care Medicine, 47, 1393-1414. [Google Scholar] [CrossRef] [PubMed]
[5] The Hypothermia after Cardiac Arrest Study Group (2002) Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest. The New England Journal of Medi-cine, 346, 549-556. [Google Scholar] [CrossRef
[6] Bernard, S.A., Gray, T.W., Buist, M.D., Jones, B.M., Silvester, W., Gutteridge, G. and Smith, K. (2002) Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia. The New England Journal of Medicine, 346, 557-563. [Google Scholar] [CrossRef
[7] Nolan, J.P., Deakin, C.D., Soar, J., Böttiger, B.W. and Smith, G. (2005) European Resuscitation Council Guidelines for Resuscitation 2005. Section 4. Adult Advanced Life Support. Re-suscitation, 67, S39-S86. [Google Scholar] [CrossRef] [PubMed]
[8] Deakin, C.D., Morrison, L.J., Morley, P.T., Callaway, C.W., Kerber, R.E., Kronick, S.L., Lavonas, E.J., Link, M.S., Neumar, R.W., Otto, C.W., et al. (2010) Part 8: Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation, 81, e93-e174. [Google Scholar] [CrossRef] [PubMed]
[9] Nielsen, N., Wetterslev, J., Cronberg, T., Erlinge, D., Gasche, Y., Hassager, C., Horn, J., Hovdenes, J., Kjaergaard, J., Kuiper, M., et al. (2013) Targeted Temperature Man-agement at 33˚C versus 36˚C after Cardiac Arrest. The New England Journal of Medicine, 369, 2197-2206. [Google Scholar] [CrossRef
[10] Sandroni, C., Nolan, J.P., Andersen, L.W., Böttiger, B.W., Cariou, A., Cronberg, T., Friberg, H., Genbrugge, C., Lilja, G., Morley, P.T. et al. (2022) ERC-ESICM Guidelines on Tempera-ture Control after Cardiac Arrest in Adults. Intensive Care Medicine, 48, 261-269. [Google Scholar] [CrossRef] [PubMed]
[11] Dankiewicz, J., Cronberg, T., Lilja, G., Jakobsen, J.C., Levin, H., Ullén, S., Rylander, C., Wise, M.P., Oddo, M., Cariou, A., et al. (2021) Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. The New England Journal of Medicine, 384, 2283-2294. [Google Scholar] [CrossRef
[12] Wang, Q., Miao, P., Modi, H.R., Garikapati, S., Koehler, R.C. and Thakor, N.V. (2019) Therapeutic Hypothermia Promotes Cerebral Blood Flow Recovery and Brain Homeostasis after Resuscitation from Cardiac Arrest in a Rat Model. Journal of Cerebral Blood Flow and Metabolism: Official Journal of the International Society of Cerebral Blood Flow and Metabolism, 39, 1961-1973. [Google Scholar] [CrossRef
[13] Gong, P., Zhao, S., Wang, J., Yang, Z., Qian, J., Wu, X., Ca-hoon, J. and Tang, W. (2015) Mild Hypothermia Preserves Cerebral Cortex Microcirculation after Resuscitation in a Rat Model of Cardiac Arrest. Resuscitation, 97, 109-114. [Google Scholar] [CrossRef] [PubMed]
[14] Xiao, F., Zhang, S., Arnold, T.C., Alexander, J.S., Huang, J., Carden, D.L. and Conrad, S.A. (2002) Mild Hypothermia Induced before Cardiac Arrest Reduces Brain Edema For-mation in Rats. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 9, 105-114. [Google Scholar] [CrossRef] [PubMed]
[15] Li, J., Li, C., Yuan, W., Wu, J., Li, J., Li, Z. and Zhao, Y. (2017) Mild Hypothermia Alleviates Brain Oedema and Blood-Brain Barrier Disruption by Attenuating Tight Junction and Adherens Junction Breakdown in a Swine Model of Cardiopulmonary Resuscitation. PLOS ONE, 12, e0174596. [Google Scholar] [CrossRef] [PubMed]
[16] Yenari, M.A. and Han, H.S. (2012) Neuroprotective Mecha-nisms of Hypothermia in Brain Ischaemia. Nature Reviews Neuroscience, 13, 267-278. [Google Scholar] [CrossRef] [PubMed]
[17] Wu, J., Yuan, W., Li, J., Zhao, Y., Li, J., Li, Z. and Li, C. (2017) Effects of Mild Hypothermia on Cerebral Large and Small Microvessels Blood Flow in a Porcine Model of Cardiac Arrest. Neuro-critical Care, 27, 297-303. [Google Scholar] [CrossRef] [PubMed]
[18] Hachimi-Idrissi, S., Van Hemelrijck, A., Michotte, A., Smolders, I., Sarre, S., Ebinger, G., Huyghens, L. and Michotte, Y. (2004) Postischemic Mild Hypothermia Reduces Neurotrans-mitter Release and Astroglial Cell Proliferation during Reperfusion after Asphyxial Cardiac Arrest in Rats. Brain Re-search, 1019, 217-225. [Google Scholar] [CrossRef] [PubMed]
[19] Gong, P., Li, C.S., Hua, R., Zhao, H., Tang, Z.R., Mei, X., Zhang, M.Y. and Cui, J. (2012) Mild Hypothermia Attenuates Mitochondrial Oxidative Stress by Protecting Respiratory Enzymes and Upregulating MnSOD in a Pig Model of Cardiac Arrest. PLOS ONE, 7, e35313. [Google Scholar] [CrossRef] [PubMed]
[20] Suh, G.J., Kwon, W.Y., Kim, K.S., Lee, H.J., Jeong, K.Y., Jung, Y.S. and Lee, J.H. (2014) Prolonged Therapeutic Hypothermia is More Effective in Attenuating Brain Apoptosis in a Swine Cardiac Arrest Model. Critical Care Medicine, 42, e132-142. [Google Scholar] [CrossRef
[21] Zhang, B., Gu, Q., Chen, X., You, Y., Chen, M., Qian, Y., Chen, Y. and Yu, W. (2021) Temperature Variability Does Not Attenuate the Beneficial Effects of Therapeutic Hypo-thermia on Cellular Apoptosis and Endoplasmic Reticulum Stress in the Cerebral Cortex of a Swine Cardiac Arrest Mod-el. Neurocritical Care, 34, 769-780. [Google Scholar] [CrossRef] [PubMed]
[22] Diao, M.Y., Zhu, Y., Yang, J., Xi, S.S., Wen, X., Gu, Q. and Hu, W. (2020) Hypothermia Protects Neurons against Ischemia/Reperfusion-Induced Pyroptosis via m6A-Mediated Ac-tivation of PTEN and the PI3K/Akt/GSK-3β Signaling Pathway. Brain Research Bulletin, 159, 25-31. [Google Scholar] [CrossRef] [PubMed]
[23] Lu, J., Qian, H.Y., Liu, L.J., Zhou, B.C., Xiao, Y., Mao, J.N., An, G.Y., Rui, M.Z., Wang, T. and Zhu, C.L. (2014) Mild Hypothermia Alleviates Excessive Autophagy and Mi-tophagy in a Rat Model of Asphyxial Cardiac Arrest. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 35, 1691-1699. [Google Scholar] [CrossRef] [PubMed]
[24] International Liaison Committee on Resuscitation (2005) Part 4: Advanced life support. Resuscitation, 67, 213-247. [Google Scholar] [CrossRef] [PubMed]
[25] Callaway, C.W., Soar, J., Aibiki, M., Böttiger, B.W., Brooks, S.C., Deakin, C.D., Donnino, M.W., Drajer, S., Kloeck, W., Morley, P.T., et al. (2015) Part 4: Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation, 132, S84-S145. [Google Scholar] [CrossRef
[26] Bray, J.E., Stub, D., Bloom, J.E., Segan, L., Mitra, B., Smith, K., Finn, J. and Bernard, S. (2017) Changing Target Temperature from 33˚C to 36˚C in the ICU Management of Out-of-Hospital Cardiac Arrest: A before and after Study. Resuscitation, 113, 39-43. [Google Scholar] [CrossRef] [PubMed]
[27] Nutma, S., Tjepkema-Cloostermans, M.C., Ruijter, B.J., Tromp, S.C., van den Bergh, W.M., Foudraine, N.A., Kornips, F.H.M., Drost, G., Scholten, E., Strang, A., et al. (2022) Effects of Targeted Temperature Management at 33˚C vs. 36˚C on Comatose Patients after Cardiac Arrest Stratified by the Severity of Encephalopathy. Resuscitation, 173, 147-153. [Google Scholar] [CrossRef] [PubMed]
[28] Fernando, S.M., Di Santo, P., Sadeghirad, B., Lascarrou, J.B., Rochwerg, B., Mathew, R., Sekhon, M.S., Munshi, L., Fan, E., Brodie, D., et al. (2021) Targeted Temperature Management Following Out-of-Hospital Cardiac Arrest: A Systematic Review and Network Meta-Analysis of Tempera-ture Targets. Intensive Care Medicine, 47, 1078-1088. [Google Scholar] [CrossRef] [PubMed]
[29] Polderman, K.H. and Varon, J. (2020) Targeted Temperature Management after Cardiac Arrest: And the Optimal Target Is….? Resuscitation, 146, 263-265. [Google Scholar] [CrossRef] [PubMed]
[30] Laurent, I., Adrie, C., Vinsonneau, C., Cariou, A., Chiche, J.D., Ohanessian, A., Spaulding, C., Carli, P., Dhainaut, J.F. and Monchi, M. (2005) High-Volume Hemofiltration after Out-of-Hospital Cardiac Arrest: A Randomized Study. JACC: Journal of the American College of Cardiology, 46, 432-437. [Google Scholar] [CrossRef] [PubMed]
[31] Deye, N., Cariou, A., Girardie, P., Pichon, N., Megarbane, B., Midez, P., Tonnelier, J.M., Boulain, T., Outin, H., Delahaye, A., et al. (2015) Endovascular versus External Targeted Temperature Management for Patients with Out-of- Hospital Cardiac Arrest: A Randomized, Controlled Study. Circula-tion, 132, 182-193. [Google Scholar] [CrossRef
[32] Matsumoto, S., Kuno, T., Mikami, T., Takagi, H., Ikeda, T., Briasoulis, A., Bortnick, A.E., Sims, D., Katz, J.N., Jentzer, J., et al. (2022) Effect of Cooling Methods and Target Temperature on Outcomes in Comatose Patients Resuscitated from Cardiac Arrest: Systematic Review and Net-work Meta-Analysis of Randomized Trials. American Heart Journal, 256, 73-84. [Google Scholar] [CrossRef] [PubMed]
[33] Lyden, P., Ernstrom, K., Cruz-Flores, S., Gomes, J., Grotta, J., Mullin, A., Rapp, K., Raman, R., Wijman, C. and Hemmen, T. (2012) Determinants of Effective Cooling during Endo-vascular Hypothermia. Neurocritical Care, 16, 413-420. [Google Scholar] [CrossRef] [PubMed]
[34] Stanger, D., Kawano, T., Malhi, N., Grunau, B., Tallon, J., Wong, G.C., Christenson, J. and Fordyce, C.B. (2019) Door- to-Targeted Temperature Management Initiation Time and Out-comes in Out-of-Hospital Cardiac Arrest: Insights from the Continuous Chest Compressions Trial. Journal of the Amer-ican Heart Association, 8, e012001. [Google Scholar] [CrossRef
[35] Glover, G.W., Thomas, R.M., Vamvakas, G., Al-Subaie, N., Cranshaw, J., Walden, A., Wise, M.P., Ostermann, M., Thomas-Jones, E., Cronberg, T., et al. (2016) Intravascular ver-sus Surface Cooling for Targeted Temperature Management after Out-of-Hospital Cardiac Arrest—An Analysis of the TTM Trial Data. Critical Care (London, England), 20, Article No. 381. [Google Scholar] [CrossRef] [PubMed]
[36] Lu, X., Ma, L., Sun, S., Xu, J., Zhu, C. and Tang, W. (2014) The Effects of the Rate of Postresuscitation Rewarming Following Hypothermia on Outcomes of Cardiopulmonary Resusci-tation in a Rat Model. Critical Care Medicine, 42, e106-113. [Google Scholar] [CrossRef
[37] Gillies, M.A., Pratt, R., Whiteley, C., Borg, J., Beale, R.J. and Tibby, S.M. (2010) Therapeutic Hypothermia after Cardiac Arrest: A Retrospective Comparison of Surface and Endovascular Cooling Techniques. Resuscitation, 81, 1117- 1122. [Google Scholar] [CrossRef] [PubMed]
[38] Diringer, M.N. (2004) Treatment of Fever in the Neuro-logic Intensive Care Unit with a Catheter-Based Heat Exchange System. Critical Care Medicine, 32, 559-564. [Google Scholar] [CrossRef
[39] Lee, B.K., Jeung, K.W., Jung, Y.H., Lee, D.H., Lee, S.M., Cho, Y.S., Heo, T., Yun, J.G. and Min, Y.I. (2017) Relationship between Timing of Cooling and Outcomes in Adult Comatose Cardiac Arrest Patients Treated with Targeted Temperature Management. Resuscitation, 113, 135-141. [Google Scholar] [CrossRef] [PubMed]
[40] Lindsay, P.J., Buell, D. and Scales, D.C. (2018) The Effi-cacy and Safety of Pre-Hospital Cooling after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. Critical Care (London, England), 22, Article No. 66. [Google Scholar] [CrossRef] [PubMed]
[41] Haugk, M., Testori, C., Sterz, F., Uranitsch, M., Holzer, M., Beh-ringer, W. and Herkner, H. (2011) Relationship between Time to Target Temperature and Outcome in Patients Treated with Therapeutic Hypothermia after Cardiac Arrest. Critical Care (London, England), 15, R101. [Google Scholar] [CrossRef] [PubMed]
[42] Panchal, A.R., Bartos, J.A., Cabañas, J.G., Donnino, M.W., Drennan, I.R., Hirsch, K.G., Kudenchuk, P.J., Kurz, M.C., Lavonas, E.J., Morley, P.T., et al. (2020) Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardio-vascular Care. Circulation, 142, S366-S468. [Google Scholar] [CrossRef
[43] Callaway, C.W., Donnino, M.W., Fink, E.L., Geocadin, R.G., Golan, E., Kern, K.B., Leary, M., Meurer, W.J., Peberdy, M.A., Thompson, T.M., et al. (2015) Part 8: Post-Cardiac Ar-rest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Car-diovascular Care. Circulation, 132, S465-S482. [Google Scholar] [CrossRef
[44] Kirkegaard, H., Søreide, E., de Haas, I., Pettilä, V., Taccone, F.S., Arus, U., Storm, C., Hassager, C., Nielsen, J.F., Søren- sen, C.A., et al. (2017) Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome after Out-of- Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA, 318, 341-350. [Google Scholar] [CrossRef] [PubMed]
[45] Shankaran, S., Laptook, A.R., Pappas, A., McDonald, S.A., Das, A., Tyson, J.E., Poindexter, B.B., Schibler, K., Bell, E.F., Heyne, R.J., et al. (2014) Effect of Depth and Du-ration of Cooling on Deaths in the NICU among Neonates with Hypoxic Ischemic Encephalopathy: A Randomized Clin-ical Trial. JAMA, 312, 2629-2639. [Google Scholar] [CrossRef] [PubMed]
[46] Rivera-Lara, L., Cho, S.M. and Geocadin, R.G. (2021) Sweeping TTM Conclusion May Deprive Many Post-Arrest Patients of Effective Therapy. Intensive Care Medicine, 47, 1509-1510. [Google Scholar] [CrossRef] [PubMed]
[47] Li, P., Sun, Z., Tian, T., Yu, D., Tian, H. and Gong, P. (2022) Recent Developments and Controversies in Therapeutic Hypothermia after Cardiopulmonary Resuscitation: A Narrative Review. The American Journal of Emergency Medicine, 64, 1-7. [Google Scholar] [CrossRef] [PubMed]