Therapeutic hypothermia after cardiac arrest (original) (raw)
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Therapeutic hypothermia and neurological outcome after cardiac arrest
Vojnosanitetski pregled, 2011
Introduction/Aim. The most important clinically relevant cause of global cerebral ischemia is cardiac arrest. Clinical studies showed a marked neuroprotective effect of mild hypothermia in resuscitation. The aim of this study was to evaluate the impact of mild hypothermia on neurological outcome and survival of the patients in coma, after cardiac arrest and return of spontaneous circulation. Methods. The prospective study was conducted on consecutive comatose patients admitted to our clinic after cardiac arrest and return of spontaneous circulation, between February 2005 and May 2009. The patients were divided into two groups: the patients treated with mild hypothermia and the patients treated conservatively. The intravascular in combination with external method of cooling or only external cooling was used during the first 24 hours, after which spontaneous rewarming started. The endpoints were survival rate and neurological outcome. The neurological outcome was observed with Cerebra...
2021
Introduction: Cardiac arrest outside medical center is a major cause of death. The survival rates ranges from 5 percent to 35 percent. In patients who are initially resuscitated, anoxic neurologic injury is the prime cause of morbidity and mortality, besides hazards in multiple organs as the kidneys, for example. Induced hypothermia has proven to improve the prognosis after resuscitation from cardiac arrest. Objective: To demonstrate in experiments where induced mild hypothermia has been able to reduce ischemic and inflammatory damage in animal's brains and consequently the multiplicity of the other organs. Methods: Experiments were carried out with rabbits and rats when mild hypothermia was induced in order to demonstrate its neuroprotective properties. Results: Induced mild hypothermia demonstrated to be able to reduce the deleterious effects caused by brain ischemia and brain inflammation. Conclusions: Hypothermia may be helpful in reducing the ischemic process as well as in reducing the inflammatory cascade caused by ischemia. We believe that induced hypothermia improves prognosis after resuscitation from cardiac arrest reinforcing the application of mild hypothermia in cases of cerebral ischemia mainly after cardiac arrest.
Improving neurological outcome after cardiac arrest: Therapeutic hypothermia the best treatment
Anesthesia: Essays and Researches, 2013
Cardiac arrest, irrespective of its etiology, has a high mortality. This event is often associated with brain anoxia which frequently causes severe neurological damage and persistent vegetative state. Only one out of every six patients survives to discharge following in-hospital cardiac arrest, whereas only 2-9% of patients who experience out of hospital cardiac arrest survive to go home. Functional outcomes of survival are variable, but poor quality survival is common, with only 3-7% able to return to their previous level of functioning. Therapeutic hypothermia is an important tool for the treatment of post-anoxic coma after cardiopulmonary resuscitation. It has been shown to reduce mortality and has improved neurological outcomes after cardiac arrest. Nevertheless, hypothermia is underused in critical care units. This manuscript aims to review the mechanism of hypothermia in cardiac arrest survivors and to propose a simple protocol, feasible to be implemented in any critical care unit.
CRITICAL CARE-LONDON-, 2002
Hypothermia as a protectant of neurologic function in the treatment of cardiac arrest patients, although not a new concept, is now supported by two recent randomized, prospective clinical trials. The basic science research in support of the effects of hypothermia at the cellular and animal levels is extensive. The process of cooling for cerebral protection holds potential promise for human resuscitation efforts in multiple realms. It appears that, at least, those patients who suffer a witnessed cardiac arrest with ventricular fibrillation and early restoration of spontaneous circulation, such as those who were included in the European and Australian trials (discussed here), should be considered for hypothermic therapy.
2014
Purpose: Although well characterized in animals, brain damage in humans treated with hypothermia after cardiac arrest has not been systematically explored. In this study we aimed to describe the characteristic trait of selective eosinophilic neuronal death (SEND), and its correlation with time to return of spontaneous circulation (ROSC) in cardiac arrest patients who died after hypothermia treatment and were referred for autopsy. Methods: Brain autopsy microscopic slides and clinical data were gathered from 23 non-survivors of cardiac arrest who were treated with hypothermia. Based on the percentage of eosinophilic neurons, a damage score 0-4 was given in 6 brain regions, and a total damage score was calculated. The damage score was correlated with time to ROSC and with neuron-specific enolase (NSE) in peripheral blood at 48 h post arrest. Results: Hippocampus had the highest damage score with a median of 3 (inter-quartile range 2-4) while the brainstem had the lowest median damage score of 0 (0-2). Total damage score showed the best correlation with time to ROSC (Spearman Rho = 0.66). Serum NSE values >33 g/L (n = 6) was associated with significantly higher mean damage score than NSE <33 g/L (n = 9) (p = 0.002). Conclusion: This is the first study to systematically describe regional SEND in patients treated with hypothermia after cardiac arrest. Hippocampus was the most vulnerable region whereas the brainstem was the most resistant. Although not directly compared here, the regional pattern of SEND seems not to be altered by hypothermia treatment, but maintains its profile distinctive for cardiac arrest pathogenesis.
Intact neurological status after induced therapeutic hypothermia in cardiac arrest
Case Reports International, 2014
Introduction: cardiac arrest patients in whom return of spontaneous circulation (rOsc) is achieved after resuscitation frequently develop irreversible neurological impairments owing to hypoxic injury and reperfusion induced cell death. therapeutic hypothermia has become a standard strategy in specific unconscious adult patients with rOsc after out-of-hospital cardiac arrest (OHcA) as per American Heart Association (AHA) guidelines. case report: A 48-year-old south Asian male arrived to our emergency department with 20 minutes duration of OHcA with no basic life support (bLs) measures en route to hospital. His initial rhythm was ventricular fibrillation and he had rOsc after 13 minutes of cardiopulmonary resuscitation (cPr) and subsequently underwent therapeutic hypothermia for 24 hours and recovered completely without neurological impairment after eight days of incident. conclusion: therapeutic hypothermia in eligible cardiac arrest patients is an important component of the post-cardiac arrest care in the AHA chain of survival. the AHA chain of survival is a chain of five interdependent links for cardiac arrest and comprises early recognition, early cPr,