心肺停止蘇生後低体温療法 - JSEPTIC

1 1 ICU Circulation. 2013;127:244-250. 2 Ca2+ MichelvHolzer, Target Temperature Manegement for Comatose Survivors of cardiac arrest . NEJM Septmber 23,2010:1256-1264 3 2010 AHA ( VF[Class I, LOE B]. [ClassIIb, LOE B]) (12-24 32 C-34 C ) . Mary Ann Peberdy, et al. post - cardiac arrest Care:Circulation. 2010;122:S768-S786 4 -1996 3 2001 1 - ,RCT - - 275 - (32-34 C).

2 - 6 5 6 ( VF/VT) (GCS<8) MichelvHolzer, Target Temperature Manegement for Comatose Survivors of cardiac arrest . NEJM Septmber 23,2010:1256-1264 Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 7 8 30 MichelvHolzer, Target Temperature Manegement for Comatose Survivors of cardiac arrest . NEJM Septmber 23,2010:1256-1264 Benjamin M.

3 Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 9 10 Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 11 1. ICU ICU 2. 3. 4. 5. 12 ICU 13 4 1 20% Mooney MR et al, therapeutic hypothermia after out-of-hospital cardiac arresst. Circulation. 2011;124:206-214 14 ex)1. 1 C 30 2. 4 C 30ml/kg/30min ( ) MichelvHolzer, Target Temperature Manegement for Comatose Survivors of cardiac arrest .

4 NEJM Septmber 23,2010:1256-1264 Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 15 ICU 16 - - 17 18 RASS-4 -5 g/kg/hr 4g 4hr Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 19 20 Benjamin M.

5 Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 21 22 32 C-34 C C (NEJM Septmber 23,2010 ) (Circulation Jannuary 15,2013 ) ) ( ) 12-24hr MichelvHolzer, Target Temperature Manegement for Comatose Survivors of cardiac arrest . NEJM Septmber 23,2010:1256-1264 Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 23 Lopez-de-Sa et al.

6 Two hypothermia Levels post cardiac arrest Trial. Circulation December11,2012 2008 3 2011 8 . RCT 36 32 C 34 C . 32 C 6 . 24 25 65-100mmHg (Circulation Jannuary 15,2013 80-100mmHg) 10-12mmHg MichelvHolzer, Target Temperature Manegement for Comatose Survivors of cardiac arrest . NEJM Septmber 23,2010:1256-1264 Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 26 (SpO2) 94-96% SpO2 -PaCO2 40-45mmHg - 35-40mmHg Benjamin M.

7 Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 27 -2001 2005 - - -4459 ICU 17 PaO2 28 4-6 1 Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 29 1 <80mg/dl 30 >200mg/dl Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 30 12 2 Benjamin M.

8 Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 31 MichelvHolzer, Target Temperature Manegement for Comatose Survivors of cardiac arrest . NEJM Septmber 23,2010:1256-1264 32 33 24 24 C/hr 37 C 48 Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 34 35 4 C (ClassI, LOE C) Benjamin M.

9 Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250 Mary Ann Peberdy, et al. post - cardiac arrest Care:Circulation. 2010;122:S768-S786 36 37 72 MRI Benjamin M. Sciria. therapeutic hypothermia After cardiac arrest :Circulation Jannuary 15,2013;127:244-250