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Authors
Advisor(s)
Abstract(s)
A hipotermia terapĂȘutica melhora a sobrevivĂȘncia e o resultado neurolĂłgico apĂłs
paragem cardĂaca ocorrida no prĂ©-hospitalar, pelo que tem sido recomendada a sua
utilização em vĂtimas com recuperação de circulação espontĂąnea. O objectivo deste estudo
foi conhecer o efeito da hipotermia terapĂȘutica prĂ©-hospitalar (HTPH) na sobrevivĂȘncia e nos
outcomes neurolĂłgicos das vĂtimas que sofreram paragem cardĂaca extra-hospitalar.
MĂ©todos: Foi realizada uma revisĂŁo sistemĂĄtica da literatura sobre estudos que
avaliavam o efeito da HTPH em vĂtimas que tinham sofrido PCR. Foi efetuada uma pesquisa
na PUBMED, EBSCO e Google Académico de estudos publicados entre Janeiro de 2007 e
31 de Maio de 2013. Os estudos encontrados foram depois avaliados tendo em
consideração os critérios de inclusão previamente estabelecidos. Dois revisores avaliaram a
qualidade dos estudos a incluir utilizando a grelha para avaliação crĂtica de um estudo
descrevendo um ensaio clinico prospetivo, aleatorizado e controlado de Carneiro (2008). Na
meta-anålise utilizou-se o método Mantel-Haenszel, recorrendo-se ao efeito de modelos
aleatĂłrios.
Resultados: Cinco RCTâs preenchiam os critĂ©rios de inclusĂŁo, envolvendo 759
participantes, sendo 378 do grupo de hipotermia pré-hospitalar e 381 do grupo controlo. A
anålise dos estudos revela que existem diferenças significativas na diminuição da
temperatura na admissĂŁo hospitalar quando utilizada a HTPH comparativamente Ă
normotermia ou hipotermia terapĂȘutica hospitalar (HTH) (IV=-1,16; IC 95%= -1,40-0,92; p
<0,00001). Contudo nĂŁo sĂŁo observadas diferenças significativas no que se refere Ă
sobrevivĂȘncia (RR=0,97; IC 95%=0,79-1,19; p=0,76) e outcomes neurolĂłgicos favorĂĄveis
(RR=0,98; IC 95%=0,79-1,20; p=0,83).
ConclusĂŁo: A HTPH diminui a temperatura na admissĂŁo hospitalar, contudo nĂŁo tem
influĂȘncia na sobrevivĂȘncia e nos outcomes neurolĂłgicos favorĂĄveis no momento da alta
hospitalar.
PALAVRAS â CHAVE: Hipotermia terapĂȘutica, PrĂ©-hospitalar, Paragem cardĂaca.
ABSTRACT Therapeutic hypothermia improves survival and neurological outcome after cardiac arrest occurred in prehospital, so that recently their use in victims with return of spontaneous circulation has been recommended. The aim of this study was to know the effect of prehospital therapeutic hypothermia (PHTH) on survival and the neurological outcomes of victims who suffered cardiac arrest outside the hospital. Methods: A systematic review of literature about studies that evaluated the effect of PHTH victims who had suffered PCR was performed. After a search (in the PubMed, EBSCO and Google Scholar) for studies published between January 2007 and May 31, 2013, were found studies and subjected to analysis, taking into account the inclusion and exclusion criteria previously established. Two reviewers evaluated the quality of the studies using the critical evaluation scale of a study describing a prospective, randomized, controlled clinical trial by Carneiro (2008). In the metha-analysis the Mantel-Haenszel Method was used, by appealing the random models effect. Results: Five RCT's involving 759 participants were selected, 378 of the group of prehospital hypothermia and 381of the control group. The studies reveal that there are significant differences in the decrease of temperature on hospital admission when used PHTH comparatively to normothermia or hypothermia therapy hospital (IV =-1.16; IC 95%= - 1.40-0.92; p < 0.00001). However no significant differences regarding survival are detected (RR= 0.97; CI 95%= 0.79-1.19; p = 0.76) and to favorable neurologic outcomes (RR = 0.98; CI 95% = 0.79-1.20 p = 0.83). Conclusion: PHTH lowers the temperature at hospital admission, however has no influence on survival and favorable neurological outcomes at hospital discharge. KEYWORDS: Therapeutic hypothermia, Prehospital, Cardiac arrest.
ABSTRACT Therapeutic hypothermia improves survival and neurological outcome after cardiac arrest occurred in prehospital, so that recently their use in victims with return of spontaneous circulation has been recommended. The aim of this study was to know the effect of prehospital therapeutic hypothermia (PHTH) on survival and the neurological outcomes of victims who suffered cardiac arrest outside the hospital. Methods: A systematic review of literature about studies that evaluated the effect of PHTH victims who had suffered PCR was performed. After a search (in the PubMed, EBSCO and Google Scholar) for studies published between January 2007 and May 31, 2013, were found studies and subjected to analysis, taking into account the inclusion and exclusion criteria previously established. Two reviewers evaluated the quality of the studies using the critical evaluation scale of a study describing a prospective, randomized, controlled clinical trial by Carneiro (2008). In the metha-analysis the Mantel-Haenszel Method was used, by appealing the random models effect. Results: Five RCT's involving 759 participants were selected, 378 of the group of prehospital hypothermia and 381of the control group. The studies reveal that there are significant differences in the decrease of temperature on hospital admission when used PHTH comparatively to normothermia or hypothermia therapy hospital (IV =-1.16; IC 95%= - 1.40-0.92; p < 0.00001). However no significant differences regarding survival are detected (RR= 0.97; CI 95%= 0.79-1.19; p = 0.76) and to favorable neurologic outcomes (RR = 0.98; CI 95% = 0.79-1.20 p = 0.83). Conclusion: PHTH lowers the temperature at hospital admission, however has no influence on survival and favorable neurological outcomes at hospital discharge. KEYWORDS: Therapeutic hypothermia, Prehospital, Cardiac arrest.
Description
Keywords
Hipotermia induzida Paragem cardĂaca RevisĂŁo Serviços mĂ©dicos de urgĂȘncia Emergency medical services Heart arrest Hypothermia, induced Review