The Impact of Heart Rate Response During 48-Hour Rewarming Phase of Therapeutic Hypothermia on Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Patients

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URI http://shark.lib.kagawa-u.ac.jp/kuir/metadata/28993
タイトル
The Impact of Heart Rate Response During 48-Hour Rewarming Phase of Therapeutic Hypothermia on Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Patients
ファイル
内容記述

Abstract

Objectives: Bradycardia during therapeutic hypothermia has been reported to be a predictor of favorable neurologic outcomes in out-of-hospital cardiac arrests. However, bradycardia occurrence rate may be influenced by the target body temperature. During therapeutic hypothermia, as part of the normal physiologic response, heart rate decreases in the cooling phase and increases during the rewarming phase. We hypothesized that increased heart rate during the rewarming phase is another predictor of favorable neurologic outcomes. To address this hypothesis, the study aimed to examine the association between heart rate response during the rewarming phase and neurologic outcomes in patients having return of spontaneous circulation after out-of-hospital cardiac arrest.

Design: A secondary analysis of the Japanese Population-based Utstein style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia registry, which was a multicenter prospective cohort study.

Setting: Fourteen hospitals throughout Japan.

Patients: Patients suffering from out-of-hospital cardiac arrest who received therapeutic hypothermia after the return of spontaneous circulation from 2005 to 2011.

Intervention: None.

Measurements and main results: This study enrolled 452 out-of-hospital cardiac arrest patients, of which 354 were analyzed, and 80.2% survived to hospital discharge, of which 57.3% had a good neurologic outcome. Heart rate response was calculated using heart rate data recorded during therapeutic hypothermia in the abovementioned registry. Heart rate response in the rewarming phase (heart rate response-rewarming) was calculated as follows: (heart rate [post rewarming]-heart rate [pre rewarming])/heart rate (pre rewarming) × 100. The primary outcome was an unfavorable neurologic outcome at hospital discharge, that is, a Cerebral Performance Category of 3-5. Multivariable logistic regression analysis was performed to determine the association between heart rate response-rewarming and unfavorable neurologic outcomes. Multivariable logistic regression analysis showed that heart rate response-rewarming was independently associated with unfavorable outcomes (odds ratio [per 10% change], 0.86; 95% CI, 0.78-0.96; p = 0.004).

Conclusions: Increased heart rate in the approximately 48-hour rewarming phase during therapeutic hypothermia was significantly associated with and was an independent predictor of favorable neurologic outcomes during out-of-hospital cardiac arrest.

(医博甲746)

著者
著者 井上 明彦
著者(ヨミ) イノウエ アキヒコ
著者(別表記) Inoue Akihiko
掲載誌
Critical care medicine
掲載誌(別表記)
Crit Care Med.
46
9
開始ページ
e881
終了ページ
e888
出版者
Society of Critical Care Medicine
Lippincott, Williams & Wilkins
出版年月日
2018-09
ISSN
0090-3493
NCID
AA00620383
PMID
29957713
DOI
10.1097/CCM.0000000000003254
資料タイプ
学位論文
言語
英語
関連情報URL
https://doi.org/10.1097/CCM.0000000000003254
該当なし
学位授与番号
博甲第746号
学位授与年月日
2020-03-24
学位名
博士(医学)
学位授与機関
香川大学
区分
香川大学
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