Hypothermia after cardiac arrest: feasible but is it therapeutic?

作者：Gary C. Fisher · 发表于：Anaesthesia · 年份：2008 · DOI：10.1111/j.1365-2044.2008.05614_1.x · 被引用次数：15 · 研究领域：Cardiac Arrest and Resuscitation、Thermal Regulation in Medicine、Intensive Care Unit Cognitive Disorders

Hay et al. [1] have added to the growing number of studies showing that hypothermia after cardiac arrest can be routinely achieved in intensive care units. They believe their audit supports the case for the wider use of a clinically effective treatment which does not require major additional critical care resources, echoing comments from an earlier survey [2] of UK practice. To someone unconvinced that deliberate hypothermia is 'therapeutic', the feasibility issue is irrelevant. What evidence is there to convince the clinically sceptic? Animal experiments suggested a promising effect but then so did similar studies on pharmacological interventions such as barbiturates, steroids and calcium antagonists, all of which failed to benefit human subjects with cerebral ischemia. The quality of hypothermia studies was noticeably weaker than those researching drugs, presumably due to funding differences, with the majority either underpowered or insufficiently blinded. Few studies are even available on which to base assumptions about the 'dose' of hypothermia needed. Even if a period of hypothermia does not appear to harm a fit rat, we then need to show that this is also true for rats that are elderly, diabetic or life-long smokers. What of the human studies? Most did not use randomised controls and we now know to discount the apparent treatment effect in studies using historical controls. The two groups are not otherwise identical and the results are generally biased in favour of the t...