To be or not to be？現今目標溫控療法的共識與爭議

To be or not to be ? Current Consensus and Controversy on Target Temperature Management

10.6530/YYN.202211_16(3).0002

蔡維哲(Wei-Che Tsai)

目標溫控治療 ； 低溫療法 ； Targeted temperature management ； Therapeutic hypothermia

源遠護理

16卷3期（2022 / 11 / 01）

12 - 20

繁體中文;英文

心跳停止（cardiac arrest）病人的復甦後照護（post acute care）目前已有基本共識，但近年來仍有些爭議的議題，包含此類病人是否需常規接受心導管檢查與經皮冠狀動脈介入治療的時機、目標溫控治療的最佳溫度，與目標溫控是否真的對病人有益處之議題，本文就目前最新研究發現與讀者分享。不論是心導管的介入處理與目標溫控的溫度選擇，最重要的是病人能否接受跨領域的整合性照護。

Over the last two decades, the use of targeted temperature management (TTM) has been recommended in the management of patients after cardiac arrest. Out-of-hospital cardiac arrest (OHCA) is a common and life-threatening complication of AMI and a population that is also widely believed to benefit from early access to PCI. Strong association between access to PCI-cap-able hospitals and outcome in resuscitated OHCA patients is suggested by observational data. However, results from recent trials such as COACT and TTM-2 have some debates in "early PCI in all resuscitated patients? and the optimal timing?" and "the real benefit of TTM? which one is the optimal temperature?" In this article, we would summarized the recent arguments and recommendation in post cardiac arrest care.

1. (2002).Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest.New England Journal of Medicine,346(8),549-556.
2. Baldi, E.,Schnaubelt, S.,Caputo, M. L.,Klersy, C.,Clodi, C.,Bruno, J.,Compagnoni, S.,Benvenuti, C.,Domanovits, H.,Burkart, R.,Fracchia, R.,Primi, R.,Ruzicka, G.,Holzer, M.,Auricchio, A.,Savastano, S.(2021).Association of Timing Return of Electrocardiogram Acquisition After of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest.JAMA Network Open,4(1),e2032875-e2032875.
3. Barbarawi, M.,Zayed, Y.,Kheiri, B.,Barbarawi, O.,Al-Abdouh, A.,Dhillon, H.,Rizk, F.,Bachuwa, G.,Alkotob, M. L.(2019).Optimal timing of coronary intervention in patients resuscitated from cardiac arrest without ST-segment elevation myocardial infarction (NSTEMI): A systematic review and meta-analysis.Resuscitation,144,137-144.
4. Berg, K. M.,Cheng, A.,Panchal, A. R.,Topjian, A. A.,Aziz, K.,Bhanji, F.,Bigham, B. L.,Hirsch, K. G.,Hoover, A. V.,Kurz, M. C.,Levy, A.,Lin, Y.,Magid, D. J.,Mahgoub, M.,Peberdy, M. A.,Rodriguez, A. J.,Sasson, C.,Lavonas, E. J.,Adult, B.,Resuscitation Education Science Writing, G.(2020).Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation,142(16_suppl_2),S580-S604.
5. Bernard, S. A.,Gray, T. W.,Buist, M. D.,Jones, B. M.,Silvester, W.,Gutteridge, G.,Smith, K.(2002).Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.N Engl J Med,346(8),557-563.
6. Collet, J. P.,Thiele, H.,Barbato, E.,Barthélémy, O.,Bauersachs, J.,Bhatt, D. L.,Dendale, P.,Dorobantu, M.,Edvardsen, T.,Folliguet, T.,Gale, C. P.,Gilard, M.,Jobs, A.,Jüni, P.,Lambrinou, E.,Lewis, B. S.,Mehilli, J.,Meliga, E.,Merkely, B.,Siontis, G. C. M.(2021).2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J,42(14),1289-1367.
7. Couper, K.,Kimani, P. K.,Gale, C. P.,Quinn, T.,Squire, I. B.,Marshall, A.,Black, J. J. M.,Cooke, M. W.,Ewings, B.,Long, J.,Perkins, G. D.(2018).Patient, health service factors and variation in mortality following resuscitated out-of-hospital cardiac arrest in acute coronary syndrome: Analysis of the Myocardial Ischaemia National Audit Project.Resuscitation,124,49-57.
8. Cournoyer, A.,Notebaert, É.,de Montigny, L.,Ross, D.,Cossette, S.,Londei-Leduc, L.,Iseppon, M.,Lamarche, Y.,Sokoloff, C.,Potter, B. J.,Vadeboncoeur, A.,Larose, D.,Morris, J.,Daoust, R.,Chauny, J. M.,Piette, É.,Paquet, J.,Cavayas, Y. A.,de Champlain, F.,Denault, A.(2018).Impact of the direct transfer to percutaneous coronary intervention-capable hospitals on survival to hospital discharge for patients with out-of-hospital cardiac arrest.Resuscitation,125,28-33.
9. Dafaalla, M.,Rashid, M.,Sun, L.,Quinn, T.,Timmis, A.,Wijeysundera, H.,Bagur, R.,Michos, E.,Curzen, N.,Mamas, M. A.(2022).Impact of availability of catheter laboratory facilities on management and outcomes of acute myocardial infarction presenting with out of hospital cardiac arrest.Resuscitation,170,327-334.
10. Dankiewicz, J.,Cronberg, T.,Lilja, G.,Jakobsen, J. C.,Levin, H.,Ullén, S.,Rylander, C.,Wise, M. P.,Oddo, M.,Cariou, A.,Bělohlávek, J.,Hovdenes, J.,Saxena, M.,Kirkegaard, H.,Young, P. J.,Pelosi, P.,Storm, C.,Taccone, F. S.,Joannidis, M.,Nielsen, N.(2021).Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest.N Engl J Med,384(24),2283-2294.
11. De Fazio, C.,Skrifvars, M. B.,Søreide, E.,Grejs, A. M.,Di Bernardini, E.,Jeppesen, A. N.,Storm, C.,Kjaergaard, J.,Laitio, T.,Rasmussen, B. S.,Tianen, M.,Kirkegaard, H.,Taccone, F. S.(2021).Quality of targeted temperature management and outcome of out-of-hospital cardiac arrest patients: A post hoc analysis of the TTH48 study.Resuscitation,165,85-92.
12. Desch, S.,Freund, A.,Akin, I.,Behnes, M.,Preusch, M. R.,Zelniker, T. A.,Skurk, C.,Landmesser, U.,Graf, T.,Eitel, I.,Fuernau, G.,Haake, H.,Nordbeck, P.,Hammer, F.,Felix, S. B.,Hassager, C.,Engstrom, T.,Fichtlscherer, S.,Ledwoch, J.,Investigators, T.(2021).Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation.N Engl J Med,385(27),2544-2553.
13. Dicker, B.,Todd, V. F.,Tunnage, B.,Swain, A.,Smith, T.,Howie, G.(2019).Direct transport to PCI-capable hospitals after out-of-hospital cardiac arrest in New Zealand: Inequities and outcomes.Resuscitation,142,111-116.
14. Ibanez, B.,James, S.,Agewall, S.,Antunes, M. J.,Bucciarelli-Ducci, C.,Bueno, H.,Caforio, A. L. P.,Crea, F.,Goudevenos, J. A.,Halvorsen, S.,Hindricks, G.,Kastrati, A.,Lenzen, M. J.,Prescott, E.,Roffi, M.,Valgimigli, M.,Varenhorst, C.,Vranckx, P.,Widimský, P.(2018).2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J,39(2),119-177.
15. Kern, K. B.,Radsel, P.,Jentzer, J. C.,Seder, D. B.,Lee, K. S.,Lotun, K.,Janardhanan, R.,Stub, D.,Hsu, C. H.,Noc, M.(2020).Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study.Circulation,142(21),2002-2012.
16. Kragholm, K.,Malta Hansen, C.,Dupre, M. E.,Xian, Y.,Strauss, B.,Tyson, C.,Monk, L.,Corbett, C.,Fordyce, C. B.,Pearson, D. A.,Fosbøl, E. L.,Jollis, J. G.,Abella, B. S.,McNally, B.,Granger, C. B.(2017).Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest.Circ Cardiovasc Qual Outcomes,10(6)
17. Lascarrou, J. B.,Merdji, H.,Le Gouge, A.,Colin, G.,Grillet, G.,Girardie, P.,Coupez, E.,Dequin, P. F.,Cariou, A.,Boulain, T.,Brule, N.,Frat, J. P.,Asfar, P.,Pichon, N.,Landais, M.,Plantefeve, G.,Quenot, J. P.,Chakarian, J. C.,Sirodot, M.,Reignier, J.(2019).Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm.N Engl J Med,381(24),2327-2337.
18. Lemkes, J. S.,Janssens, G. N.,van der Hoeven, N. W.,Jewbali, L. S. D.,Dubois, E. A.,Meuwissen, M.,Rijpstra, T. A.,Bosker, H. A.,Blans, M. J.,Bleeker, G. B.,Baak, R.,Vlachojannis, G. J.,Eikemans, B. J. W.,van der Harst, P.,van der Horst, I. C. C.,Voskuil, M.,van der Heijden, J. J.,Beishuizen, A.,Stoel, M.,van Royen, N.(2019).Coronary Angiography after Cardiac Arrest without ST-Segment Elevation.N Engl J Med,380(15),1397-1407.
19. Lick, C. J.,Aufderheide, T. P.,Niskanen, R. A.,Steinkamp, J. E.,Davis, S. P.,Nygaard, S. D.,Bemenderfer, K. K.,Gonzales, L.,Kalla, J. A.,Wald, S. K.,Gillquist, D. L.,Sayre, M. R.,Osaki Holm, S. Y.,Öakes, D. A.,Provo, T. A.,Racht, E. M.,Olsen, J. D.,Yannopoulos, D.,Lurie, K. G.(2011).Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest.Crit Care Med,39(1),26-33.
20. Matsuyama, T.,Kiyohara, K.,Kitamura, T.,Nishiyama, C.,Nishiuchi, T.,Hayashi, Y.,Kawamura, T.,Ohta, B.,Iwami, T.(2017).Hospital characteristics and favourable neurological outcome among patients with out-of-hospital cardiac arrest in Osaka, Japan.Resuscitation,110,146-153.
21. Minini, A.,Annoni, F.,Peluso, L.,Bogossian, E. G.,Creteur, J.,Taccone, F. S.(2021).Which Target Temperature for Post-Anoxic Brain Injury? A Systematic Review from "Real Life" Studies.Brain Sci,11(2)
22. Nielsen, N.,Wetterslev, J.,Cronberg, T.,Erlinge, D.,Gasche, Y.,Hassager, C.,Horn, J.,Hovdenes, J.,Kjaergaard, J.,Kuiper, M.,Pellis, T.,Stammet, P.,Wanscher, M.,Wise, M. P.,Åneman, A.,Al-Subaie, N.,Boesgaard, S.,Bro-Jeppesen, J.,Brunetti, I.,Friberg, H.(2013).Targeted temperature management at 33°C versus 36°C after cardiac arrest.N Engl J Med,369(23),2197-2206.
23. Nolan, J. P.,Sandroni, C.,Böttiger, B. W.,Cariou, A.,Cronberg, T.,Friberg, H.,Genbrugge, C.,Haywood, K.,Lilja, G.,Moulaert, V. R. M.,Nikolaou, N.,Mariero Olasveengen, T.,Skrifvars, M. B.,Taccone, F.,Soar, J.(2021).European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care.Resuscitation,161,220-269.
24. Olai, H.,Thornéus, G.,Watson, H.,Macleod, M.,Rhodes, J.,Friberg, H.,Nielsen, N.,Cronberg, T.,Deierborg, T.(2020).Meta-analysis of targeted temperature management in animal models of cardiac arrest.Intensive Care Med Exp,8(1),3.
25. Patterson, T.,Perkins, A.,Perkins, G. D.,Clayton, T.,Evans, R.,Nguyen, H.,Wilson, K.,Whitbread, M.,Hughes, J.,Fothergill, R. T.,Nevett, J.,Mosweu, I.,McCrone, P.,Dalby, M.,Rakhit, R.,MacCarthy, P.,Perera, D.,Nolan, J. P.,Redwood, S. R.(2018).Rationale and design of: A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation out-of-hospital cardiac arrest: The ARREST randomized controlled trial.Am Heart J,204,92-101.
26. Patterson, T.,Perkins, G. D.,Hassan, Y.,Moschonas, K.,Gray, H.,Curzen, N.,de Belder, M.,Nolan, J. P.,Ludman, P.,Redwood, S. R.(2018).Temporal Trends in Identification, Management, and Clinical Outcomes After Out-of-Hospital Cardiac Arrest: Insights From the Myocardial Ischaemia National Audit Project Database.Circ Cardiovasc Interv,11(6),e005346.
27. Patterson, T.,Perkins, G. D.,Joseph, J.,Wilson, K.,Van Dyck, L.,Robertson, S.,Nguyen, H.,McConkey, H.,Whitbread, M.,Fothergill, R.,Nevett, J.,Dalby, M.,Rakhit, R.,MacCarthy, P.,Perera, D.,Nolan, J. P.,Redwood, S. R.(2017).A Randomised tRial of Expedited transfer to a cardiac arrest centre for non-ST elevation ventricular fibrillation out-of-hospital cardiac arrest: The ARREST pilot randomised trial.Resuscitation,115,185-191.
28. Salam, I.,Hassager, C.,Thomsen, J. H.,Langkjær, S.,Søholm, H.,Bro-Jeppesen, J.,Bang, L.,Holmvang, L.,Erlinge, D.,Wanscher, M.,Lippert, F. K.,Køber, L.,Kjaergaard, J.(2016).Editor's Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?.Eur Heart J Acute Cardiovasc Care,5(4),317-326.
29. Sinning, C.,Ahrens, I.,Cariou, A.,Beygui, F.,Lamhaut, L.,Halvorsen, S.,Nikolaou, N.,Nolan, J. P.,Price, S.,Monsieurs, K.,Behringer, W.,Cecconi, M.,Van Belle, E.,Jouven, X.,Hassager, C.(2020).The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause-aims, function and structure: Position paper of the Association for Acute Cardio Vascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM).Eur Heart J Acute Cardiovasc Care,9(4_suppl),S193-s202.
30. Spaite, D. W.,Bobrow, B. J.,Stolz, U.,Berg, R. A.,Sanders, A. B.,Kern, K. B.,Chikani, V.,Humble, W.,Mullins, T.,Stapczynski, J. S.,Ewy, G. A.(2014).Statewide regionalization of postarrest care for out-of-hospital cardiac arrest: association with survival and neurologic outcome.Ann Emerg Med,64(5),496-506.e491.
31. Stub, D.,Schmicker, R. H.,Anderson, M. L.,Callaway, C. W.,Daya, M. R.,Sayre, M.,Peterson, E. D.,Nichol, G.(2015).Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest.Resuscitation,92,45-52.
32. Taccone, F. S.,Picetti, E.,Vincent, J. L.(2020).High Quality Targeted Temperature Management (TTM) After Cardiac Arrest.Crit Care,24(1),6.
33. von Vopelius-Feldt, J.,Perkins, G. D.,Benger, J.(2021).Association between admission to a cardiac arrest centre and survival to hospital discharge for adults following out-of-hospital cardiac arrest: A multi-centre observational study.Resuscitation,160,118-125.
34. Yeung, J.,Matsuyama, T.,Bray, J.,Reynolds, J.,Skrifvars, M. B.(2019).Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? -A systematic review.Resuscitation,137,102-115.