Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock (original) (raw)
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Therapeutic hypothermia as a treatment option after out-ofhospital cardiac arrest: our experience
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2019
Aim To examine the effects of therapeutic hypothermia on the outcome of patients with the diagnosis of out-of-hospital cardiac arrest (OHCA). Methods The study included 76 patients who were hospitalised at the Medical Intensive Care Unit (MICU) of the Clinical Centre University of Sarajevo, with the diagnosis of out-of-hospital cardiac arrest, following the return of spontaneous circulation. Therapeutic hypothermia was performed with an average temperature of 33oC (32.3 - 34.1o C) on the patients who had coma, according to the Glasgow Coma Scale (GCS). Results Multiple organ dysfunction syndrome (MODS) significantly affected survival (p=0.0001), as its presence reduced patients' survival by 96%. In addition, ventricular fibrillation (VF) as the presenting rhythm, also significantly affected survival (p=0.019). A degree of patient's coma, as measured by the GCS, significantly affected survival (p=0.011). For each increasing point on the GCS, the chance for survival increased ...
The American Journal of Cardiology, 2011
Mild therapeutic hypothermia has proved beneficial after out-of-hospital cardiac arrest in the adult population, when the initial rhythm is ventricular fibrillation (VF). In this study, data from 110 consecutive patients with out-of-hospital cardiac arrest due to VF (n ؍ 86) or to non-VF rhythm (n ؍ 24), admitted to an intensive cardiac care unit with restoration of spontaneous circulation and who remained unconscious on admission, were analyzed. Patients were cooled using an external cooling system. Of the patients with VF, 66% had favorable outcomes (Glasgow-Pittsburgh Cerebral Performance Category 1 or 2), and 30% died. Of the patients with non-VF, 8% had favorable outcomes (p <0.001 vs VF), and 63% died (p ؍ 0.004 vs VF). In patients with VF, those with poor outcomes were older than those with favorable outcomes (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.03 to 2.7, p ؍ 0.001) and had previous ejection fractions <35% (OR 7.72, 95% CI 1.8 to 33, p ؍ 0.002). Outcomes were also worse when patients presented to the emergency room with seizures (OR 20.96, 95% CI 2.48 to 177.42, p ؍ 0.003) or hemodynamic instability (OR 14.4, 95% CI 3.47 to 60, p <0.0001). In the non-VF group, the 2 patients with good outcomes were younger than those with unfavorable outcomes (39 ؎ 16 vs 65 ؎ 12 years, respectively, p ؍ 0.04), with good left ventricular function on presentation (100% vs 4.5%, p ؍ 0.0001) and with short asystole and/or short time from collapse to restoration of spontaneous circulation. In conclusion, mild therapeutic hypothermia in the adult population is more effective in patients with VF compared to those with non-VF. Good prognostic factors for patients with non-VF could be young age, good left ventricular function, and short anoxic time.
European Heart Journal: Acute Cardiovascular Care, 2014
Background: Aggressive post-resuscitation care, in particular combining mild therapeutic hypothermia (MTH) with early coronary angiography (CAG) and percutaneous coronary intervention (PCI), may improve prognosis after outof-hospital cardiac arrest (OHCA). Objectives: The study aims to assess the value of immediate CAG or PCI in comatose survivors after OHCA treated with MTH and their association with outcomes. Methods: Observational, prospective analysis of all comatose, resuscitated patients treated with MTH at a tertiary centre and undergoing CAG or PCI ≤6 hours after OHCA, or non-invasively managed. Primary outcomes were 30-day and 1-year survival. Results: From March 2004-December 2012, 141 (51%) out of 278 comatose patients after cardiac OHCA were treated with MTH (median age: 64.5 (interquartile range 55-73) years, males: 67%, first shockable rhythm: 70%, witnessed OHCA: 94%, interval OHCA-resuscitation≤20 min: 81%). Ninety-seven patients (69%) underwent early CAG, and 45 (32%) of them PCI. Patients undergoing CAG or PCI had a more favourable risk profile than subjects non-invasively managed. PCI treated patients had more bleedings, but no stent thrombosis occurred. Thirty-day and one-year unadjusted total mortality rates were 50% and 72% for non-invasively managed patients, 26% and 38.7% for patients submitted only to CAG and 32% and 36.6% for patients treated with PCI (p=0.0435 for early death, and p<0.0001 for one-year mortality, respectively). However, a propensity-matched score analysis did not confirm the survival advantage of invasive management (p=0.093). At multivariable analysis, clinical and OHCA-related variables as well as CAG, but not PCI, were associated with outcomes. Conclusions: Comatose patients cooled after OHCA and submitted to emergency CAG or PCI are a favourable outcome population that receives optimal post-arrest care.
Despite high levels of public awareness, the widespread use of automatic external defibrillators and the ongoing education of doctors in advanced life support seminars, the percentage of victims who arrive at the hospital after out-of-hospital cardiac arrest (OHCA) is small. Of those who reach the hospital, the main cause of death in two thirds of the cases is persistent neurologic disability. The only therapy that has so far seemed to positively affect the neurological outcome of patients after cardiac arrest is mild therapeutic hypothermia (MTH). However, the application of MTH is also known to be associated with a number of potential adverse effects, and recent trials report on an increasing rate of stent thrombosis. If the results are confirmed, safe levels of temperature regulation would need to be defined. Recently, a study was published that takes a critical approach to MTH. Hypothermia was compared to targeted temperature management near normothermia. After the end of the study period, there was no statistically significant difference regarding the survival to discharge and the neurological prognosis at 180 days. The authors stress that in both groups the temperature was actively controlled to avoid temperatures over 37 degrees Celsius. There followed few more publications with similar findings. The most important message from these trial is that even if the aggressive regulation of temperature with the form of hypothermia may seem unjustified, this does not mean that fever should be left untreated. Normothermia is a goal that can be achieved rather easily and can also save the lives of many patients.