2022年ERC-ESICM成人心脏骤停后温度控制临床实践指南解读

Interpretation of the 2022 ERC-ESICM clinical practice guidelines for temperature control in adults after cardiac arrest

基于随机对照试验、系统评价和荟萃分析,心脏骤停复苏后患者使用目标温度管理(TTM)进行温度控制已得到专家协会的认可和国际临床实践指南的推荐。近期TTM-2试验报告指出具有任何初始心律的1850例院外心脏骤停(OHCA)昏迷患者温度控制在33℃与仅在患者发热(>37.7℃)时进行干预,6个月的病死率或神经功能结局没有差异,故欧洲复苏委员会(ERC)和欧洲危重病医学会(ESICM)更新了温度控制的临床实践指南,为具有任何初始节律的院内或院外心脏骤停复苏后昏迷的成人患者提供基于循证的体温控制指导。本文对其重点内容进行解读,为国内临床医师更好的学习和了解最新进展。

Based on randomized controlled trials, systematic reviews, and meta-analyses, the use of temperature control with target temperature management(TTM) in patients after resuscitation from cardiac arrest has been endorsed by expert associations and recommended by international clinical practice guidelines. The recent TTM-2 trial reported that there was no difference in 6 months-mortality or neurological outcomes in 1850 out-of-hospital cardiac arrest(OHCA) coma patients with any initial rhythm between temperature control at 33℃ and intervention only in patients with fever, defined as body temperature>37.7℃. Therefore, the European Resuscitation Council(ERC) and the European Society of Intensive Care Medicine(ESICM) have updated clinical practice guidelines to provide evidence-based guidance on temperature control in adults patients who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest with any initial cardiac rhythm. This paper interprets the key contents in order to better learn and understand the latest progress for domestic clinicians.