{"id":17151,"date":"2019-05-12T05:16:55","date_gmt":"2019-05-11T21:16:55","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17151"},"modified":"2019-06-02T06:39:10","modified_gmt":"2019-06-01T22:39:10","slug":"jama%e6%9c%80%e6%96%b0%e8%ae%ba%e6%96%87%ef%bc%9a-2","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17151","title":{"rendered":"[JAMA\u6700\u65b0\u8bba\u6587]\uff1a\u5fc3\u8df3\u9aa4\u505c\u671f\u95f4\u7ecf\u9f3b\u84b8\u6c7d\u51b7\u5374\u5bf9\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u60a3\u8005\u795e\u7ecf\u7cfb\u7edf\u529f\u80fd\u9884\u540e\u7684\u5f71\u54cd\u2014PRINCESS\u7814\u7a76\u7ed3\u679c"},"content":{"rendered":"\n

Original Investigation|Caring for the Critically Ill PatientMay 7, 2019<\/h3>\n\n\n\n

Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest: The PRINCESS Randomized Clinical Trial<\/h1>\n\n\n\n

Per Nordberg, Fabio Silvio Taccone, Anatolij Truhlar, et al<\/h3>\n\n\n\n

JAMA. <\/em>2019;321(17):1677-1685. doi:10.1001\/jama.2019.4149<\/h3>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h2>\n\n\n\n

Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest).<\/p>\n\n\n\n

\u5fc3\u8df3\u9aa4\u505c\u540e\u5b9e\u65bd\u6cbb\u7597\u6027\u4f4e\u6e29\u80fd\u591f\u589e\u52a0\u5b58\u6d3b\u4e14\u795e\u7ecf\u7cfb\u7edf\u9884\u540e\u826f\u597d\u7684\u60a3\u8005\u6bd4\u4f8b\u3002\u7ecf\u9f3b\u84b8\u6c7d\u51b7\u5374\u662f\u5728\u5fc3\u80ba\u590d\u82cf\u671f\u95f4\u4e3b\u8981\u7528\u4e8e\u8111\u90e8\u51b7\u5374\u7684\u65b9\u6cd5\u3002<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h2>\n\n\n\n

To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves survival with good neurologic outcome compared with cooling initiated after hospital arrival.<\/p>\n\n\n\n

\u786e\u5b9a\u4e0e\u62b5\u8fbe\u533b\u9662\u540e\u5f00\u59cb\u964d\u6e29\u6cbb\u7597\u76f8\u6bd4\uff0c\u9662\u524d\u5fc3\u8df3\u9aa4\u505c\u671f\u95f4\u7ecf\u9f3b\u84b8\u6c7d\u51b7\u5374\u80fd\u5426\u6539\u5584\u5b58\u6d3b\u4e14\u795e\u7ecf\u7cfb\u7edf\u9884\u540e\u826f\u597d\u7684\u60a3\u8005\u6bd4\u4f8b\u3002<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u4eba\u7fa4<\/h2>\n\n\n\n

The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiac arrest were enrolled.<\/p>\n\n\n\n

PRINCESS\u8bd5\u9a8c\u662f\u4e00\u9879\u7814\u7a76\u8005\u53d1\u8d77\u7684\u968f\u673a\u4e34\u5e8a\u56fd\u9645\u591a\u4e2d\u5fc3\u7814\u7a76\u3002\u75317\u4e2a\u6b27\u6d32\u56fd\u5bb6\u7684\u6025\u8bca\u533b\u7597\u670d\u52a1\u8fdb\u884c\uff0c\u7814\u7a76\u671f\u9650\u4e3a2010\u5e747\u6708\u81f32018\u5e741\u6708\uff0c\u6700\u540e\u968f\u8bbf\u65e5\u671f\u4e3a2018\u5e744\u670829\u65e5\uff0c\u9884\u540e\u8bc4\u4f30\u8bbe\u76f2\u3002\u5171\u5165\u9009677\u540d\u65c1\u89c2\u8005\u76ee\u51fb\u7684\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u60a3\u8005\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd<\/h2>\n\n\n\n

Patients were randomly assigned to receive trans-nasal evaporative intra-arrest cooling (n\u2009=\u2009343) or standard care (n\u2009=\u2009334). Patients admitted to the hospital in both groups received systemic therapeutic hypothermia at 32\u00b0C to 34\u00b0C for 24 hours.<\/p>\n\n\n\n

\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d7\u5fc3\u8df3\u9aa4\u505c\u671f\u95f4\u7ecf\u9f3b\u84b8\u6c7d\u51b7\u5374(n = 343)\u6216\u6807\u51c6\u6cbb\u7597(n = 334)\u3002\u4e24\u7ec4\u60a3\u8005\u5165\u9662\u540e\u5747\u63a5\u53d7\u5168\u8eab\u6cbb\u7597\u6027\u4f4e\u6e29\u6cbb\u759724\u5c0f\u65f6\uff0c\u7ef4\u6301\u6838\u5fc3\u4f53\u6e2932\u00b0C\u81f334\u00b0C\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h2>\n\n\n\n

The primary outcome was survival with good neurologic outcome, defined as Cerebral Performance Category (CPC) 1-2, at 90 days. Secondary outcomes were survival at 90 days and time to reach core body temperature less than 34\u00b0C.<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u5b58\u6d3b\u4e14\u795e\u7ecf\u7cfb\u7edf\u9884\u540e\u826f\u597d\uff0c\u5b9a\u4e49\u4e3a90\u5929\u65f6\u8111\u529f\u80fd\u5206\u7c7b(CPC) 1-2\u5206\u3002\u6b21\u8981\u9884\u540e\u6307\u6807\u4e3a90\u5929\u751f\u5b58\u7387\uff0c\u53ca\u6838\u5fc3\u4f53\u6e29\u8fbe\u523034\u00b0C\u4ee5\u4e0b\u6240\u9700\u65f6\u95f4\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h2>\n\n\n\n

Among the 677 randomized patients (median age, 65 years; 172 [25%] women), 671 completed the trial. Median time to core temperature less than 34\u00b0C was 105 minutes in the intervention group vs 182 minutes in the control group (P<\/em>\u2009<\u2009.001). The number of patients with CPC 1-2 at 90 days was 56 of 337 (16.6%) in the intervention cooling group vs 45 of 334 (13.5%) in the control group (difference, 3.1% [95% CI, \u22122.3% to 8.5%]; relative risk [RR], 1.23 [95% CI, 0.86-1.72]; P<\/em>\u2009=\u2009.25). In the intervention group, 60 of 337 patients (17.8%) were alive at 90 days vs 52 of 334 (15.6%) in the control group (difference, 2.2% [95% CI, \u22123.4% to 7.9%]; RR, 1.14 [95% CI, 0.81-1.57]; P<\/em>\u2009=\u2009.44). Minor nosebleed was the most common device-related adverse event, reported in 45 of 337 patients (13%) in the intervention group. The adverse event rate within 7 days was similar between groups.<\/p>\n\n\n\n

\u603b\u5171 677 \u540d\u63a5\u53d7\u968f\u673a\u5206\u7ec4\u7684\u60a3\u8005\uff08\u4e2d\u4f4d\u5e74\u9f84\uff0c65 \u5c81\uff1b172 \u540d[25%] \u5973\u6027\uff09\uff0c671\u540d\u60a3\u8005\u5b8c\u6210\u4e34\u5e8a\u8bd5\u9a8c\u3002\u5e72\u9884\u7ec4\u6838\u5fc3\u4f53\u6e29\u8fbe\u523034\u00b0C\u4ee5\u4e0b\u6240\u9700\u65f6\u95f4\u4e2d\u4f4d\u6570\u4e3a 105 \u5206\u949f\uff0c\u5bf9\u7167\u7ec4\u4e3a182 \u5206\u949f(P<\/em>\u2009<\u2009.001)\u300290\u5929\u65f6\uff0c\u5e72\u9884\u7ec4337\u540d\u60a3\u8005\u4e2d56\u540d (16.6%)\u53ca\u5bf9\u7167\u7ec4334\u540d\u60a3\u8005\u4e2d45\u540d (13.5%)\u7684CPC\u8bc4\u52061-2\u5206\uff08\u5dee\u5f02\uff0c3.1% [95% CI, \u22122.3% to 8.5%]; \u76f8\u5bf9\u5371\u9669\u5ea6 [RR], 1.23 [95% CI, 0.86-1.72]; P<\/em>\u2009=\u2009.25\uff09\u300290\u5929\u65f6\uff0c\u5e72\u9884\u7ec4337\u540d\u60a3\u8005\u4e2d60\u540d (17.8%)\u53ca\u5bf9\u7167\u7ec4334\u540d\u60a3\u8005\u4e2d52\u540d (15.6%) \u5b58\u6d3b\uff08\u5dee\u5f02\uff0c2.2% [95% CI, \u22123.4% to 7.9%]; RR, 1.14 [95% CI, 0.81-1.57]; P<\/em>\u2009=\u2009.44\uff09\u3002\u8f7b\u5ea6\u9f3b\u51fa\u8840\u662f\u6700\u5e38\u89c1\u7684\u8bbe\u5907\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6\uff0c\u5e72\u9884\u7ec4337\u540d\u60a3\u8005\u4e2d45\u540d(13%)\u51fa\u73b0\u8f7b\u5ea6\u9f3b\u51fa\u8840\u3002\u4e24\u7ec4\u60a3\u80057\u5929\u5185\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u76f8\u4f3c\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong> \u7ed3\u8bba\u4e0e\u610f\u4e49<\/h2>\n\n\n\n

Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days.<\/p>\n\n\n\n

\u5bf9\u4e8e\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u60a3\u8005\uff0c\u4e0e\u5e38\u89c4\u6cbb\u7597\u76f8\u6bd4\uff0c\u5fc3\u8df3\u9aa4\u505c\u671f\u95f4\u7ecf\u9f3b\u84b8\u6c7d\u51b7\u5374\u5e76\u4e0d\u80fd\u663e\u8457\u6539\u558490\u5929\u65f6\u5b58\u6d3b\u4e14\u795e\u7ecf\u7cfb\u7edf\u9884\u540e\u826f\u597d\u60a3\u8005\u6bd4\u4f8b\u3002<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT01400373<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation|Caring for the Critically Ill Pa […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17151"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17151"}],"version-history":[{"count":4,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17151\/revisions"}],"predecessor-version":[{"id":17156,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17151\/revisions\/17156"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17151"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17151"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17151"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}