High resolution ecg changes in survivors of out-of-hospital cardiac arrest during and after mild therapeutic hypothermia (original) (raw)
Related papers
Computing in Cardiology 2014, 2014
Our aim was to evaluate electrocardiographic (ECG) differences between survivors and non-survivors of out of hospital cardiac arrest (OHCA). The study included 76 patients that suffered from OHCA. In all patients, serum arterial lactate was obtained on admission to the intensive care unit was obtained as an index of ischemia during cardiac arrest and resuscitation. A 5-minute 12-lead high fidelity ECG recording was recorded during mild therapeutic hypothermia (MTH) (defined as core body temperature of 32-34°C). Custom software programs were used to calculate conventional and advanced spatial, repolarisation and interval variability ECG parameters. Survival versus non survival to hospital discharge was considered as the outcome variable. There were 38 survivors of OHCA among our patients. Survivors displayed significantly lower serum arterial lactate levels and lower values of beat-to-beat QT interval variability parameters. We conclude that a relatively greater degree of anoxic injury in patients that fail to survive OHCA results in altered electrophysiological properties of the heart muscle leading to increased ventricular repolarisation variability.
Resuscitation
Therapeutic hypothermia improves neurologic outcomes in patients resuscitated from cardiac arrest due to ventricular fibrillation. However, its role in patients with cardiac arrest due to non-shockable rhythms (pulseless electrical activity (PEA) and asystole) is unclear. We hypothesized that therapeutic hypothermia favorably impacts neurologic outcome and survival in patients resuscitated from cardiac arrest due to non-shockable rhythms.Retrospectively collected data on consecutive adult patients admitted to Hartford Hospital from 1/1/2004 to 11/1/2010 who survived a cardiac arrest due to PEA or asystole were analyzed. Patients who underwent therapeutic hypothermia (1/1/2007–11/1/2010) formed the hypothermia group while patients admitted prior to the institution of therapeutic hypothermia (1/1/2004–1/1/2007) at Hartford Hospital formed the control group. The primary end-point was measured using the Pittsburgh cerebral performance category (CPC) scale and patients were assessed for a good (CPC 1 and 2) or poor (CPC 3–5) neurological outcome prior to discharge from hospital. A secondary end-point was measured as survival at discharge from hospital.Of 100 post-cardiac arrest patients included in the study, 15/52 (29%) patients in the hypothermia group had a good neurologic outcome as compared to 5/43 (10%) patients in the control group (P = 0.021). On multivariate analysis, the odds ratio for good neurologic outcome and survival at discharge from the hospital with therapeutic hypothermia as compared to control were 4.35 (95% CI 1.10–17.24, P = 0.04) and 5.65 (CI 1.66–19.23, P = 0.006) respectively.Therapeutic hypothermia is associated with favorable neurologic outcome and survival in patients resuscitated after cardiac arrest due to non-shockable rhythms.
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.
Critical care medicine, 2018
Bradycardia during therapeutic hypothermia has been reported to be a predictor of favorable neurologic outcomes in out-of-hospital cardiac arrests. However, bradycardia occurrence rate may be influenced by the target body temperature. During therapeutic hypothermia, as part of the normal physiologic response, heart rate decreases in the cooling phase and increases during the rewarming phase. We hypothesized that increased heart rate during the rewarming phase is another predictor of favorable neurologic outcomes. To address this hypothesis, the study aimed to examine the association between heart rate response during the rewarming phase and neurologic outcomes in patients having return of spontaneous circulation after out-of-hospital cardiac arrest. A secondary analysis of the Japanese Population-based Utstein style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia registry, which was a multicenter prospective cohort study. Fourteen h...
Hypothermia and cardiac electrophysiology: a systematic review of clinical and experimental data
Cardiovascular Research, 2018
Moderate therapeutic hypothermia procedures are used in post-cardiac arrest care, while in surgical procedures, lower core temperatures are often utilized to provide cerebral protection. Involuntary reduction of core body temperature takes place in accidental hypothermia and ventricular arrhythmias are recognized as a principal cause for a high mortality rate in these patients. We assessed both clinical and experimental literature through a systematic literature search in the PubMed database, to review the effect of hypothermia on cardiac electrophysiology. From included studies, there is common experimental and clinical evidence that progressive cooling will induce changes in cardiac electrophysiology. The QT interval is prolonged and appears more sensitive to decreases in temperature than the QRS interval. Severe hypothermia is associated with more pronounced changes, some of which are proarrhythmic. This is supported clinically where severe accidental hypothermia is commonly asso...
Hypothermia after cardiac arrest
Critical Care Medicine, 1991
Mild therapeutic hypothermia (32°C-34°C) is the only therapy that improved neurological outcome after cardiac arrest in a randomized, controlled trial. Induced hypothermia after successful resuscitation leads to one additional patient with intact neurological outcome for every 6 patients treated. It protects the brain after ischemia by reduction of brain metabolism, attenuation of reactive oxygen species formation, inhibition of excitatory amino acid release, attenuation of the immune response during reperfusion, and inhibition of apoptosis. Potential side effects such as infections have to be kept in mind and treated accordingly. Mild hypothermia is a safe and effective therapy after cardiac arrest, even in hemodynamically compromised patients and in patients undergoing percutaneous coronary intervention. Its use is recommended by the American Heart Association and the International Liaison Committee on Resuscitation for unconscious adult patients with spontaneous circulation after out-of-hospital ventricular fibrillation cardiac arrest. Further research is needed to maximize its potential benefits. (Prog Cardiovasc Dis 2009;52:168-179)
Resuscitation, 2011
Aim: Mild therapeutic hypothermia (32-34 • C) improves neurological recovery and reduces the risk of death in comatose survivors of cardiac arrest when the initial rhythm is ventricular fibrillation or pulseless ventricular tachycardia. The aim of the presented study was to investigate the effect of mild therapeutic hypothermia (32-34 • C for 24 h) on neurological outcome and mortality in patients who had been successfully resuscitated from non-ventricular fibrillation cardiac arrest. Methods: In this retrospective cohort study we included cardiac arrest survivors of 18 years of age or older suffering a witnessed out-of-hospital cardiac arrest with asystole or pulseless electric activity as the first documented rhythm. Data were collected from 1992 to 2009. Main outcome measures were neurological outcome within six month and mortality after six months. Results: Three hundred and seventy-four patients were analysed. Hypothermia was induced in 135 patients. Patients who were treated with mild therapeutic hypothermia were more likely to have good neurological outcomes in comparison to patients who were not treated with hypothermia with an odds ratio of 1.84 (95% confidence interval: 1.08-3.13). In addition, the rate of mortality was significantly lower in the hypothermia group (odds ratio: 0.56; 95% confidence interval: 0.34-0.93). Conclusion: Treatment with mild therapeutic hypothermia at a temperature of 32-34 • C for 24 h is associated with improved neurological outcome and a reduced risk of death following out-of-hospital cardiac arrest with non-shockable rhythms.
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,
Is Hypothermia After Cardiac Arrest Effective in Both Shockable and Nonshockable Patients?
Circulation, 2011
Background— Although the level of evidence of improvement is significant in cardiac arrest patients resuscitated from a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia [VF/V t ]), the use of therapeutic mild hypothermia (TMH) is more controversial in nonshockable patients (pulseless electric activity or asystole [PEA/asystole]). We therefore assessed the prognostic value of hypothermia for neurological outcome at hospital discharge according to first-recorded cardiac rhythm in a large cohort. Methods and Results— Between January 2000 and December 2009, data from 1145 consecutive out-of-hospital cardiac arrest patients in whom a successful resuscitation had been achieved were prospectively collected. The association of TMH with a good neurological outcome at hospital discharge (cerebral performance categories level 1 or 2) was quantified by logistic regression analysis. TMH was induced in 457/708 patients (65%) in VF/V t and in 261/437 patients (60%) i...