摘要
OBJECTIVES: The study examined the effect of isovolumic high-volume hemofiltration(HF) alone or combined with mild hypothermia(HT) on survival after out-of-hospital cardiac arrest(OHCA) with initial ventricular fibrillation or asystole. BACKGROUND: Global inflammation in response to whole-body ischemia-reperfusion is common after OHCA and may worsen the overall prognosis. METHODS: Sixty-one patients admitted between May 2000 and March 2002 in the intensive care units of two hospitals in France were randomized to one of three groups: control, HF(200 ml/kg/h over 8 h) or HF+HT(32℃for 24 h) induced by cooling the HF substitution fluid. Standard supportive care was provided in all three groups. The primary end point was survival with a follow-up time of six months. The effect of HF on death by intractable shock was the secondary end point. RESULTS: The six-month survival curves of the three groups were significantly different, with better survival in the HF group(p=0.026) and in the HF+HT group(p=0.018). After adjustment on baseline characteristics of cardiac arrest, HF(with or without HT) was associated with improved survival(logistic regression odds ratio, 4.4; 95%confidence interval[CI], 1.1 to 16.6). Compared to control group, the relative risk of death by intractable shock was 0.29(95%CI, 0.09 to 0.91) in the HF+HT group and 0.21(95%CI, 0.05 to 0.85) in the HF group. CONCLUSIONS: The HF may improve the overall prognosis after resuscitation from OHCA. Combination of HF with mild HT is feasible and should be evaluated in larger trials.
OBJECTIVES: The study examined the effect of isovolumic high-volume hemofiltration(HF) alone or combined with mild hypothermia(HT) on survival after out-of-hospital cardiac arrest(OHCA) with initial ventricular fibrillation or asystole. BACKGROUND: Global inflammation in response to whole-body ischemia-reperfusion is common after OHCA and may worsen the overall prognosis. METHODS: Sixty-one patients admitted between May 2000 and March 2002 in the intensive care units of two hospitals in France were randomized to one of three groups: control, HF(200 ml/kg/h over 8 h) or HF+HT(32℃for 24 h) induced by cooling the HF substitution fluid. Standard supportive care was provided in all three groups. The primary end point was survival with a follow-up time of six months. The effect of HF on death by intractable shock was the secondary end point. RESULTS: The six-month survival curves of the three groups were significantly different, with better survival in the HF group(p=0.026) and in the HF+HT group(p=0.018). After adjustment on baseline characteristics of cardiac arrest, HF(with or without HT) was associated with improved survival(logistic regression odds ratio, 4.4; 95%confidence interval[CI], 1.1 to 16.6). Compared to control group, the relative risk of death by intractable shock was 0.29(95%CI, 0.09 to 0.91) in the HF+HT group and 0.21(95%CI, 0.05 to 0.85) in the HF group. CONCLUSIONS: The HF may improve the overall prognosis after resuscitation from OHCA. Combination of HF with mild HT is feasible and should be evaluated in larger trials.
