intra-arrest hypothermia during cardiac arrest a systematic review在心脏骤停系统回顾intra-arrest体温过低.pdfVIP

Scolletta et al. Critical Care 2012, 16:R41 /content/16/2/R41 RESEARCH Open Access Intra-arrest hypothermia during cardiac arrest: a systematic review 1 1 2 1 1* Sabino Scolletta , Fabio Silvio Taccone , Per Nordberg , Katia Donadello , Jean-Louis Vincent and Maaret Castren3 Abstract Introduction: Therapeutic hypothermia is largely used to protect the brain following return of spontaneous circulation (ROSC) after cardiac arrest (CA), but it is unclear whether we should start therapeutic hypothermia earlier, that is, before ROSC. Methods: We performed a systematic search of PubMed, EMBASE, CINAHL, the Cochrane Library and Ovid/Medline databases using “arrest” OR “cardiac arrest” OR “heart arrest” AND “hypothermia” OR “therapeutic hypothermia” OR “cooling” as keywords. Only studies using intra-arrest therapeutic hypothermia (IATH) were selected for this review. Three authors independently assessed the validity of included studies and extracted data regarding characteristics of the studied cohort (animal or human) and the main outcomes related to the use of IATH: Mortality, neurological status and cardiac function (particularly, rate of ROSC). Results: A total of 23 animal studies (level of evidence (LOE) 5) and five human studies, including one randomized controlled trial (LOE 1), one retrospective and one prospective controlled study (LOE 3), and two prospective studies without a control group (LOE 4), were identified. IATH improved survival and neurological outcomes when compared to normothermia and/or hypothermia after ROSC. IATH was also associated with improved ROSC rates and with improved cardiac function, including better left ventricular function, and reduced myocardial i