In accordo con i dati presenti in letteratura [104, 105], da questo studio è emersa, in termini di mortalità alla dimissione dalla Terapia Intensiva e di outcome neurologico a 6 mesi, l’efficacia dell’ipotermia terapeutica in pazienti che si presentavano privi di coscienza dopo arresto cardiaco, con qualsiasi ritmo di presentazione, trattati nella U.O. Anestesia e Rianimazione Pronto Soccorso.
L’ipotermia non è stata associata ad un aumento delle complicanze emorragiche, infettive e aritmiche, rispetto al gruppo storico di controllo trattato con cure intensive standard.
La mortalità in Terapia Intensiva, in linea con la letteratura, è ridotta nel gruppo dei pazienti sottoposti a trattamento ipotermico rispetto a quella del gruppo controllo, risultato che raggiunge la significatività statistica (p 0.049).
La percentuale di pazienti con outcome neurologico favorevole (CPC 1-2) a 6 mesi dall’arresto cardiaco è risultata maggiore nel gruppo trattato con ipotermia rispetto a quella del gruppo controllo. Questo dato, in linea con la letteratura, non raggiunge tuttavia una significatività statistica (p 0.694) a causa dell’esiguità del campione.
In questi anni è emersa inoltre la necessità, nella U.O. Rianimazione Pronto Soccorso, di utilizzare device specifici per assicurare a tutti i pazienti il trattamento ipotermico secondo un protocollo prestabilito senza gravare sul personale infermieristico.
Aspetti ancora scarsamente definiti risultano essere la temperatura target ottimale di raffreddamento del paziente, la durata della fase di mantenimento, la velocità del riscaldamento e le categorie di pazienti da sottoporre a ipotermia terapeutica.
Questi ultimi due aspetti, in particolare, sembrano rivestire un ruolo chiave per lo sviluppo di studi futuri sul trattamenti ipotermico. La velocità di riscaldamento, infatti, potrebbe rivelarsi di importanza fondamentale per il ruolo neuroprotettivo dell’ipotermia e l’estensione del trattamento a nuove categorie di pazienti secondo criteri di inclusioni più ampi (bambini e donne in gravidanza) potrebbe aprire nuovi orizzonti terapeutici.
Potrebbe infine rivelarsi molto utile prolungare oltre l’anno il periodo di follow up sia per studiare meglio il timing di stabilizzazione del recupero neurologico sia per analizzare con maggiore attenzione anche la sfera delle alterazioni della personalità. Dato il riconoscimento del ruolo neuroprotettivo dell’ipotermia terapeutica per i pazienti vittime di arresto cardiaco, emerge la necessità, confermata dalla letteratura [202], di centralizzare i pazienti vittime di arresto cardiaco verso strutture che siano in grado di assicurare il trattamento ipotermico secondo protocolli condivisi da varie figure professionali (medico del servizio di emergenza territoriale, infermiere, cardiologo, emodinamista, anestesista-rianimatore ecc.) e che permettano, in ultima analisi, di raccogliere in modo omogeneo dati per lo sviluppo di studi futuri.
Per definire meglio il trattamento ipotermico anche in termini di target termico, di tempistica delle varie fasi, di criteri di inclusione, di complicanze e di predittività degli indici prognostici, emerge la necessità di condurre uno studio prospettico, controllato e randomizzato su un campione ampio e omogeneo di pazienti.
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