Abstract：
Rewarming therapies for accidental hypothermia (AH) include extracorporeal membrane oxygenation (ECMO) and non-ECMO related (conventional) therapies. However, there are limited data available to inform the selection of conventional rewarming therapy. The aim of the present study was to explore what patients\' factors and which rewarming therapy predicted favorable prognosis.
This study is a secondary analysis of the Intensive Care with Extra Corporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study, a multicenter prospective, observational study conducted in Japan. Enrolled in the ICE-CRASH study were patients aged ≥18 years with a core temperature of ≤32 °C who were transported to the emergency departments of 36 tertiary care hospitals in Japan between 1 December 2019 and 31 March 2022, among whom those who were rewarmed with conventional rewarming therapy were included in the present study. Logistic regression analysis was performed with 28-day survival as the objective variable; and seven factors including age, activities of daily living (ADL) independence, sequential organ failure assessment (SOFA) score, and each rewarming technique as explanatory variables. We performed linear regression analysis to identify whether each rewarming technique was associated with rewarming rate.
Of the 499 patients enrolled in the ICE-CRASH study, 371 were eligible for this secondary analysis. The median age was 81 years, 50.9% were male, and the median initial body temperature was 28.8 °C. Age (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.94-1.00) and SOFA score (OR: 0.73, 95% CI: 0.67-0.81) were associated with lower survival, whereas ADL independence (OR: 2.31, 95% CI: 1.15-4.63) was associated with higher survival. No conventional rewarming therapy was associated with 28-day survival. Hot bath was associated with a high rewarming rate (regression coefficient: 1.14, 95% CI: 0.75-1.53).
No conventional rewarming therapy was associated with improved 28-day survival, which suggests that background factors such as age, ADL, and severity of condition contribute more to prognosis than does the selection of rewarming technique.
This study is a secondary analysis of the Intensive Care with Extra Corporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study, a multicenter prospective, observational study conducted in Japan. Enrolled in the ICE-CRASH study were patients aged ≥18 years with a core temperature of ≤32 °C who were transported to the emergency departments of 36 tertiary care hospitals in Japan between 1 December 2019 and 31 March 2022, among whom those who were rewarmed with conventional rewarming therapy were included in the present study. Logistic regression analysis was performed with 28-day survival as the objective variable; and seven factors including age, activities of daily living (ADL) independence, sequential organ failure assessment (SOFA) score, and each rewarming technique as explanatory variables. We performed linear regression analysis to identify whether each rewarming technique was associated with rewarming rate.
Of the 499 patients enrolled in the ICE-CRASH study, 371 were eligible for this secondary analysis. The median age was 81 years, 50.9% were male, and the median initial body temperature was 28.8 °C. Age (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.94-1.00) and SOFA score (OR: 0.73, 95% CI: 0.67-0.81) were associated with lower survival, whereas ADL independence (OR: 2.31, 95% CI: 1.15-4.63) was associated with higher survival. No conventional rewarming therapy was associated with 28-day survival. Hot bath was associated with a high rewarming rate (regression coefficient: 1.14, 95% CI: 0.75-1.53).
No conventional rewarming therapy was associated with improved 28-day survival, which suggests that background factors such as age, ADL, and severity of condition contribute more to prognosis than does the selection of rewarming technique.
摘要：
背景：意外低温（AH）的复温疗法包括体外膜氧合（ECMO）和非ECMO相关（常规）疗法。然而,可用于选择常规复温疗法的数据有限.本研究的目的是探讨哪些患者因素以及哪些复温疗法可预测良好的预后。
方法：本研究是对意外严重低温（ICE-CRASH）研究中使用体外膜氧合再加热的重症监护的二次分析，一个多中心的前瞻性，在日本进行的观察研究。参加ICE-CRASH研究的患者年龄≥18岁，核心温度≤32°C，在2019年12月1日至2022年3月31日期间被送往日本36家三级护理医院的急诊科，其中接受常规复温治疗的患者被纳入本研究。以28天生存率为客观变量进行Logistic回归分析;年龄、日常生活活动(ADL)独立性，序贯器官衰竭评估（SOFA）评分，和每个复温技术作为解释变量。我们进行了线性回归分析，以确定每种复温技术是否与复温率相关。
结果：在参加ICE-CRASH研究的499名患者中，371人符合此二次分析的条件。中位年龄为81岁,50.9%为男性，初始体温中位数为28.8°C。年龄（比值比[OR]：0.97，95％置信区间[CI]：0.94-1.00）和SOFA评分（OR：0.73，95％CI：0.67-0.81）与较低的生存率相关，而ADL独立性(OR:2.31,95%CI:1.15-4.63)与较高的生存率相关。没有常规复温治疗与28天生存率相关。热浴与高复温率相关(回归系数:1.14,95%CI:0.75-1.53)。
结论：没有常规复温治疗可改善28天生存率，这表明背景因素，如年龄，ADL,与选择复温技术相比，病情的严重程度对预后的影响更大。
方法：本研究是对意外严重低温（ICE-CRASH）研究中使用体外膜氧合再加热的重症监护的二次分析，一个多中心的前瞻性，在日本进行的观察研究。参加ICE-CRASH研究的患者年龄≥18岁，核心温度≤32°C，在2019年12月1日至2022年3月31日期间被送往日本36家三级护理医院的急诊科，其中接受常规复温治疗的患者被纳入本研究。以28天生存率为客观变量进行Logistic回归分析;年龄、日常生活活动(ADL)独立性，序贯器官衰竭评估（SOFA）评分，和每个复温技术作为解释变量。我们进行了线性回归分析，以确定每种复温技术是否与复温率相关。
结果：在参加ICE-CRASH研究的499名患者中，371人符合此二次分析的条件。中位年龄为81岁,50.9%为男性，初始体温中位数为28.8°C。年龄（比值比[OR]：0.97，95％置信区间[CI]：0.94-1.00）和SOFA评分（OR：0.73，95％CI：0.67-0.81）与较低的生存率相关，而ADL独立性(OR:2.31,95%CI:1.15-4.63)与较高的生存率相关。没有常规复温治疗与28天生存率相关。热浴与高复温率相关(回归系数:1.14,95%CI:0.75-1.53)。
结论：没有常规复温治疗可改善28天生存率，这表明背景因素，如年龄，ADL,与选择复温技术相比，病情的严重程度对预后的影响更大。
