Theraputic Hypothermia for cerebral protection after Cardiac arrest (original) (raw)
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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.
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...
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.
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.
Hypothermia after cardiac arrest: a treatment that works
Current Opinion in Critical Care, 2003
Sudden death from cardiac arrest is a major health problem that still receives too little publicity. Current therapy after cardiac arrest concentrates on resuscitation efforts because, until now, no specific therapy for brain protection after restoration of spontaneous circulation was available. Therapeutic mild or moderate resuscitative hypothermia is a novel therapy with multifaceted chemical and physical effects by preventing or mitigating the derangements seen in the postresuscitation syndrome.
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.