收稿日期: 2024-05-24
网络出版日期: 2025-01-22
Effectiveness of targeted temperature management in patients with cardiac arrest:an overview of systematic reviews
目的 对目标体温管理(targeted temperature management,TTM)在心搏骤停(cardiac arrest,CA)患者中应用系统评价再评价,为临床医护人员提供证据支持。方法 计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library和CINAHL数据库,纳入评估TTM在CA患者中应用效果的系统评价/Meta分析,检索时限为建库至2024年1月15日。由2名研究者独立筛选文献并提取数据,通过计算修正覆盖面积评估原始研究重叠程度,分别通过AMSTAR 2工具、PRISMA 2020报告规范、GRADE证据分级系统评价纳入文献的方法学、报告和证据质量,采用描述性分析的方式对结果进行呈现。结果 共纳入23篇系统评价/Meta分析,CCA为10.32%,原始研究高度重叠。AMSTAR 2评价结果显示,高质量文献2篇、中等质量2篇、低质量8篇、极低质量11篇;PRISMA 2020评价结果显示,12篇报告相对完全,11篇报告有一定缺陷;GRADE评价结果显示,55个证据体中等质量8个、低质量25个、极低质量22个。描述性分析结果显示,TTM在改善神经功能恢复、提高生存率、降低病死率和提高生活质量方面对CA患者具有潜在益处,但对成本效益、住院时间等的效果仍需进一步证实。结论 TTM在改善CA患者的神经功能恢复和生存、降低其病死率和提高其生活质量方面具有潜在益处,但目前最佳体温等尚未明确,且相关系统评价/Meta分析质量有待提高。未来学者应着眼于探讨个性化治疗策略,并提高临床护士对TTM的认知水平和实践能力,从而确保TTM治疗效果,改善CA患者预后。
李鑫 , 黎张双子 , 崔安妮 , 徐傲然 , 韩亚贤 . 目标体温管理在心搏骤停患者中应用效果的系统评价再评价[J]. 中华急危重症护理杂志, 2025 , 6(2) : 173 -180 . DOI: 10.3761/j.issn.2096-7446.2025.02.008
Objective To summarize,evaluate and analyze the related systematic reviews/meta-analyses of the application of targeted temperature management(TTM) in patients with cardiac arrest(CA),so as to provide evidence support for clinical medical staff. Methods CNKI,Wanfang,VIP,CBM,PubMed,Embase,Web of Science,Cochrane Library and CINAHL databases were searched by computer. Systematic reviews/meta-analyses evaluating the application effect of TTM in patients with CA were included. The search time limit was from the establishment of the database to January 15,2024. Two researchers independently screened the literature and extracted the data,assessed the extent of original study overlap by calculating Corrected Covered Area(CCA). AMSTAR 2 tool,PRISMA 2020 reporting standard and GRADE evidence grading system were used to evaluate the methodology,reporting and evidence quality of the included studies,respectively. Descriptive analysis was used to present the results. Results A total of 23 systematic reviews/meta-analyses were included. The original studies were highly overlapping by calculating a CCA of 10.32%. The results of AMSTAR 2 evaluation showed that 2 articles were of high quality,2 articles were of medium quality,8 articles were of low quality and 11 articles were of very low quality. The results of PRISMA 2020 evaluation showed that 12 reports were relatively complete,and 11 reports had certain defects. The GRADE evaluation results showed that 8 of the 55 evidence bodies were medium quality,25 were low quality,and 22 were very low quality.The results of descriptive analysis showed that TTM has potential benefits for CA patients in terms of improving neurological function recovery,improving survival rate,reducing mortality and improving quality of life,but its effects on cost-effectiveness and length of hospital stay need to be further confirmed. Conclusion TTM has potential benefits in improving neurological recovery and survival,decreasing their death rate and improving their quality of life in CA patients,but the optimal body temperature has not yet been clarified and the quality of related systematic reviews/meta-analyses needs to be improved. Future scholars should aim to explore personalized treatment strategies and improve the level of knowledge and practice of TTM among clinical nurses,so as to ensure the effectiveness of TTM treatment and improve the prognosis of CA patients.
[1] | Vazquez AR, Sudhir A. Cardiac arrest as a public health issue[J]. Emerg Med Clin North Am, 2023, 41(3):405-411. |
[2] | Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2022 update:a report from the American Heart Association[J]. Circulation, 2022, 145(8):e153-e639. |
[3] | 中国心脏骤停与心肺复苏报告编写组, 徐峰, 陈玉国. 中国心脏骤停与心肺复苏报告(2022年版)概要[J]. 中国循环杂志, 2023, 38(10):1005-1017. |
Writing Committee of the Report on Cardiac Arrest and Cardiopulmonary Resuscitation in China, Xu F, Chen YG. Report on cardiac arrest and cardiopulmonary resuscitation in China(2022):a summary[J]. Chin Circ J, 2023, 38(10):1005-1017. | |
[4] | Panchal AR, Bartos JA, Caba?as JG, et al. Part 3:adult basic and advanced life support:2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2):S366-S468. |
[5] | 慕文静, 樊落, 朱伟, 等. 我国目标体温管理研究热点的共词聚类分析[J]. 护士进修杂志, 2023, 38(5):466-469. |
Mu WJ, Fan L, Zhu W, et al. Co-word cluster analysis of research hotspots of target body temperature management in China[J]. J Nurses Train, 2023, 38(5):466-469. | |
[6] | Pieper D, Antoine SL, Mathes T, et al. Systematic review finds overlapping reviews were not mentioned in every other overview[J]. J Clin Epidemiol, 2014, 67(4):368-375. |
[7] | 张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018, 10(1):14-18. |
Zhang FY, Shen AM, Zeng XT, et al. An introduction to AMSTAR 2:a critical appraisal tool for systematic reviews[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(1):14-18. | |
[8] | 高亚, 刘明, 杨珂璐, 等. 系统评价报告规范:PRISMA 2020与PRISMA 2009的对比分析与实例解读[J]. 中国循证医学杂志, 2021, 21(5):606-616. |
Gao Y, Liu M, Yang KL, et al. Reporting guideline for systematic review:comparative analysis of PRISMA 2020 and PRISMA 2009[J]. Chin J Evid Based Med, 2021, 21(5):606-616. | |
[9] | 曾宪涛, 冷卫东, 李胜, 等. 如何正确理解及使用GRADE系统[J]. 中国循证医学杂志, 2011, 11(9):985-990. |
Zeng XT, Leng WD, Li S, et al. How to understand and use GRADE system correctly? A briefly outline[J]. Chin J Evid Based Med, 2011, 11(9):985-990. | |
[10] | Matsumoto S, Kuno T, Mikami T, et al. Effect of cooling methods and target temperature on outcomes in comatose patients resuscitated from cardiac arrest:systematic review and network meta-analysis of randomized trials[J]. Am Heart J, 2023, 256:73-84. |
[11] | MacLaren R, Torian S, Kiser T, et al. Therapeutic hypothermia following cardiopulmonary arrest:a systematic review and meta-analysis with trial sequential analysis[J]. J Crit Care Med, 2023, 9(2):64-72. |
[12] | Granfeldt A, Holmberg MJ, Nolan JP, et al. Temperature control after adult cardiac arrest:an updated systematic review and meta-analysis[J]. Resuscitation, 2023, 191:109928. |
[13] | Chiu PY, Chung CC, Tu YK, et al. Therapeutic hypothermia in patients after cardiac arrest:a systematic review and meta-analysis of randomized controlled trials[J]. Am J Emerg Med, 2023, 71:182-189. |
[14] | Arrich J, Schütz N, Oppenauer J, et al. Hypothermia for neuroprotection in adults after cardiac arrest[J]. Cochrane Database Syst Rev, 2023, 5(5):CD004128. |
[15] | Zhu YB, Yao Y, Ren Y, et al. Targeted temperature management for cardiac arrest due to non-shockable rhythm:a systematic review and meta-analysis of randomized controlled trials[J]. Front Med, 2022, 9:910560. |
[16] | Shrestha DB, Sedhai YR, Budhathoki P, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest:a systematic review and meta-analysis of randomized controlled trials[J]. Ann Med Surg, 2022, 74:103327. |
[17] | Elbadawi A, Sedhom R, Baig B, et al. Targeted hypothermia vs targeted normothermia in survivors of cardiac arrest:a systematic review and meta-analysis of randomized trials[J]. Am J Med, 2022, 135(5):626-633.e4. |
[18] | Sanfilippo F, la Via L, Lanzafame B, et al. Targeted tempera-ture management after cardiac arrest:a systematic review and meta-analysis with trial sequential analysis[J]. J Clin Med, 2021, 10(17):3943. |
[19] | Fernando SM, di Santo P, Sadeghirad B, et al. Targeted tem-perature management following out-of-hospital cardiac arrest:a systematic review and network meta-analysis of temperature targets[J]. Intensive Care Med, 2021, 47(10):1078-1088. |
[20] | Barbarawi M, Alabdouh A, Barbarawi O, et al. Targeted tem-perature management in cardiac arrest patients with an initial non-shockable rhythm:a systematic review and meta-analysis[J]. Shock, 2020, 54(5):623-630. |
[21] | 俞慧, 周从阳, 万筱明, 等. 亚低温治疗对心搏骤停患者预后影响的Meta分析[J]. 重庆医学, 2018, 47(28):3680-3683. |
Yu H, Zhou CY, Wan XM, et al. Efficacy of mild hypothermia on the prognosis of patients with cardiac arrest:a Meta-analysis[J]. Chongqing Med, 2018, 47(28):3680-3683. | |
[22] | Kalra R, Arora G, Patel N, et al. Targeted temperature management after cardiac arrest:systematic review and meta-analyses[J]. Anesth Analg, 2018, 126(3):867-875. |
[23] | Hakim SM, Ammar MA, Reyad MS. Effect of therapeutic hypothermia on survival and neurological outcome in adults suffering cardiac arrest:a systematic review and meta-analysis[J]. Minerva Anestesiol, 2018, 84(6):720-730. |
[24] | Song LJ, Wei L, Zhang L, et al. The role of targeted temperature management in adult patients resuscitated from nonshockable cardiac arrests:an updated systematic review and meta-analysis[J]. Biomed Res Int, 2016, 2016:2350974. |
[25] | Schenone AL, Cohen A, Patarroyo G, et al. Therapeutic hypothermia after cardiac arrest:a systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature[J]. Resuscitation, 2016, 108:102-110. |
[26] | Patel JK, Parikh PB. Association between therapeutic hypothermia and long-term quality of life in survivors of cardiac arrest:a systematic review[J]. Resuscitation, 2016, 103:54-59. |
[27] | Bhattacharjee S, Baidya DK, Maitra S. Therapeutic hypothermia after cardiac arrest is not associated with favorable neurological outcome:a meta-analysis[J]. J Clin Anesth, 2016, 33:225-232. |
[28] | 钱会银, 朱建良, 邹勤华, 等. 治疗性低温对心脏骤停患者神经功能预后和存活率影响的Meta分析[J]. 中华急诊医学杂志, 2015, 24(9):1017-1022. |
Qian HY, Zhu JL, Zou QH, et al. Effectiveness of therapeutic hypothermia on neurological status and survival in patients after cardiac arrest:a Meta-analysis[J]. Chin J Emerg Med, 2015, 24(9):1017-1022. | |
[29] | Zhang XW, Xie JF, Chen JX, et al. The effect of mild induced hypothermia on outcomes of patients after cardiac arrest:a systematic review and meta-analysis of randomised controlled trials[J]. Crit Care, 2015, 19:417. |
[30] | Vargas M, Servillo G, Sutherasan Y, et al. Effects of in-hospital low targeted temperature after out of hospital cardiac arrest:a systematic review with meta-analysis of randomized clinical trials[J]. Resuscitation, 2015, 91:8-18. |
[31] | 王晓萍, 林庆明, 赵燊, 等. 亚低温治疗心搏骤停患者的疗效评价[J]. 中华急诊医学杂志, 2013, 22(6):616-621. |
Wang XP, Lin QM, Zhao S, et al. The efficacy of mild hypothermia for the treatment of patients successfully resuscitated from cardiac arrest:a meta-analysis[J]. Chin J Emerg Med, 2013, 22(6):616-621. | |
[32] | Kim YM, Yim HW, Jeong SH, et al. Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?:a systematic review and meta-analysis of randomized and non-randomized studies[J]. Resuscitation, 2012, 83(2):188-196. |
[33] | A. Alexander S, 高雯. 目标体温管理在脑保护中的应用研究进展[J]. 中华急危重症护理杂志, 2020, 1(5):468-474. |
A. Alexander S, Gao W. Targeted temperature management for saving brain tissue:development of a science with practical applications[J]. Chin J Emerg Criti Care Nurs, 2020, 1(5):468-474. | |
[34] | 逄利, 穆宇航, 邢吉红. 心肺复苏后的目标体温管理[J]. 中华急诊医学杂志, 2023, 32(1):13-16. |
Pang L, Mu YH, Xing JH. Management of target body temperature after cardiopulmonary resuscitation[J]. Chin J Emerg Med, 2023, 32(1):13-16. | |
[35] | 马莉, 杜兰芳, 马青变, 等. 北京市护理人员对心脏骤停患者目标体温管理的现状调查[J]. 中华护理杂志, 2019, 54(9):1373-1378. |
Ma L, Du LF, Ma QB, et al. Current status of targeted tempera-ture management for cardiac arrest patients:a survey of nurses in Beijing[J]. Chin J Nurs, 2019, 54(9):1373-1378. | |
[36] | Nielsen N, Friberg H. Changes in practice of controlled hypothermia after cardiac arrest in the past 20 years:a critical care perspective[J]. Am J Respir Crit Care Med, 2023, 207(12):1558-1564. |
[37] | Perman SM, Bartos JA, Del Rios M, et al. Temperature management for comatose adult survivors of cardiac arrest:a science advisory from the American Heart Association[J]. Circulation, 2023, 148(12):982-988. |
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