Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients : a post hoc analysis of a nationwide, multicenter prospective registry
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著者
書誌事項
- タイトル
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Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients : a post hoc analysis of a nationwide, multicenter prospective registry
- 著者名
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岡﨑, 智哉
- 学位授与大学
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香川大学
- 取得学位
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博士(医学)
- 学位授与番号
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甲第747号
- 学位授与年月日
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2020-03-24
注記・抄録
Background: The International Liaison Committee on Resuscitation guidelines recommend target temperature management (TTM) between 32 and 36 °C for patients after out-of-hospital cardiac arrest, but did not indicate patient-specific temperatures. The association of serum lactate concentration and neurological outcome in out-of-hospital cardiac arrest patient has been reported. The study aim was to investigate the benefit of 32-34 °C in patients with various degrees of hyperlactatemia compared to 35-36 °C.
Methods: This study was a post hoc analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest registry between June 2014 and December 2015. Patients with complete targeted temperature management and lactate data were eligible. Patients were stratified to mild (< 7 mmol/l), moderate (< 12 mmol/l), or severe (≥ 12 mmol/l) hyperlactatemia group based on lactate concentration after return of spontaneous circulation. They were subdivided into 32-34 °C or 35-36 °C groups. The primary endpoint was an adjusted predicted probability of 30-day favorable neurological outcome, defined as a cerebral performance category score of 1 or 2.
Result: Of 435 patients, 139 had mild, 182 had moderate, and 114 had severe hyperlactatemia. One hundred and eight (78%) with mild, 128 with moderate (70%), and 83 with severe hyperlactatemia (73%) received TTM at 32-34 °C. The adjusted predicted probability of a 30-day favorable neurological outcome following severe hyperlactatemia was significantly greater with 32-34 °C (27.4%, 95% confidence interval: 22.0-32.8%) than 35-36 °C (12.4%, 95% CI 3.5-21.2%; p = 0.005). The differences in outcomes in those with mild and moderate hyperlactatemia were not significant.
Conclusions: In OHCA patients with severe hyperlactatemia, the adjusted predicted probability of 30-day favorable neurological outcome was greater with TTM at 32-34 °C than with TTM at 35-36 °C. Further evaluation is needed to determine whether TTM at 32-34 °C can improve neurological outcomes in patients with severe hyperlactatemia after out-of-hospital cardiac arrest.
科研費 基盤研究(C) 16K09034
科研費 基盤研究(B) 15H05006
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-16K09034/
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-15H05006/