심정지 환자의 저체온 치료에 있어 체외 저체온 유도방식과 체내 저체온 유도방식의 효능 (The Efficacy of Surface and Endovascular Cooling Methods During Therapeutic Hypothermia after Cardiac Arrest)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 21권 / 1호 / 19 ~ 27페이지
· 저자명 : 박원빈, 김진주, 임용수, 김재광, 현성열, 황성연, 이근, 양혁준

초록

Purpose: According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, unconscious adult patients with ROSC after out-of-hospital cardiac arrest should be cooled to between 32℃ and 34℃ for 12 to 24hours. Two recent randomized controlled trials that included comatose survivors of cardiac arrest have documented that therapeutic hypothermia improved the neurological recovery.
(ED note: Newer cooling devices have recently been introduced, such as endovascular…?)We have introduced newer devices, such as endovascular cooling devices, so we compared endovascular cooling with the previously used surface cooling methods.
Methods: This is a cohort study of patients with ROSC (>24hours) after cardiac arrest and who were admitted to the intensive care unit in a tertiary hospital over a twentyeight month period from September 2006 to December 2008 and they had received therapeutic hypothermia. The patients’baseline characteristics, the mortality, the neurologic outcomes, the side effects during therapeutic hypothermia and other factors were evaluated according to the cooling methods.
Results: Seventy-five patients were included over a 28month period. Surface cooling methods were used in 37patients, and endovascular cooling methods were used in 38 patients. There were no significant differences of the mortality and the neurologic outcome according to the cooling methods (p=0.973, 0.937). The time from collapse to reaching therapeutic hypothermia was 587.14±384.18minutes for surface cooling and 496.24±213.83 minutes for endovascular cooling (p=0.105). The rewarming time was 451.09±229.93 minutes and 802.38±209.09 minutes for each cooling method, respectively, and the difference was statistically significant (p=0.002). There were no significant differences of the side effects during therapeutic hypothermia between the surface and endovascular cooling methods.
Conclusion: Endovascular cooling methods are useful to maintain the target temperature within a narrower range and these methods have the advantage of automatic feedback control of the temperature and controlled rewarming.
There were no significant differences in mortality, the neurologic outcome and other side effects between the surface and endovascular cooling methods during therapeutic hypothermia after cardiac arrest.

영어초록

Purpose: According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, unconscious adult patients with ROSC after out-of-hospital cardiac arrest should be cooled to between 32℃ and 34℃ for 12 to 24hours. Two recent randomized controlled trials that included comatose survivors of cardiac arrest have documented that therapeutic hypothermia improved the neurological recovery.
(ED note: Newer cooling devices have recently been introduced, such as endovascular…?)We have introduced newer devices, such as endovascular cooling devices, so we compared endovascular cooling with the previously used surface cooling methods.
Methods: This is a cohort study of patients with ROSC (>24hours) after cardiac arrest and who were admitted to the intensive care unit in a tertiary hospital over a twentyeight month period from September 2006 to December 2008 and they had received therapeutic hypothermia. The patients’baseline characteristics, the mortality, the neurologic outcomes, the side effects during therapeutic hypothermia and other factors were evaluated according to the cooling methods.
Results: Seventy-five patients were included over a 28month period. Surface cooling methods were used in 37patients, and endovascular cooling methods were used in 38 patients. There were no significant differences of the mortality and the neurologic outcome according to the cooling methods (p=0.973, 0.937). The time from collapse to reaching therapeutic hypothermia was 587.14±384.18minutes for surface cooling and 496.24±213.83 minutes for endovascular cooling (p=0.105). The rewarming time was 451.09±229.93 minutes and 802.38±209.09 minutes for each cooling method, respectively, and the difference was statistically significant (p=0.002). There were no significant differences of the side effects during therapeutic hypothermia between the surface and endovascular cooling methods.
Conclusion: Endovascular cooling methods are useful to maintain the target temperature within a narrower range and these methods have the advantage of automatic feedback control of the temperature and controlled rewarming.
There were no significant differences in mortality, the neurologic outcome and other side effects between the surface and endovascular cooling methods during therapeutic hypothermia after cardiac arrest.

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