Hipotermia terapêutica em pacientes pós-parada cardiorrespiratória: mecanismos de ação e desenvolvimento de protocolo assistencial

Rech, Tatiana Helena; Vieira, Sílvia Regina Rios

doi:10.1590/s0103-507x2010000200015

Cited by 6 publications

(5 citation statements)

References 60 publications

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“…З іншого боку, за результатами багатоцентрових досліджень доведено, що терапевтична гіпотермія (ТГ) має нейро-і кардіопротекторну дію, і використовується як один з невідкладних методів при наданні первинної медичної допомоги [5]. Перспективним у цьому напрямі вбачається поєднання використання ТГ із трансплантацією МСК.…”

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Ultrasound assessment of heart remodelling affected by therapeutic hypothermia and MSC on myocardial infarction model

et al. 2020

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Background. Late seeking medical advice, limited number of cardiac surgery hospitals and conservative treatment, which does not seem to be always efficacious, trigger the search for new, more effective mode therapy of acute myocardial infarction (MI). Recently, mesenchymal stromal cells (MSCs) have come into sharp focus of scientists due to the prospects for clinical use. On the other hand, multicenter studies have proved that therapeutic hypothermia (TH) has neuro- and cardioprotective effects, and it is administered as one of the urgent methods in providing primary health care. Purpose. Providing and analyzing ultrasonography (US) of rat hearts with experimental MI in order to determine the nature of heart remodelling under combined use of TH and introducing allogeneic MSCs. Materials and methods. The study involved 90 outbred white rats weighing 240–270 g. Myocardial infarction was reproduced by ligating the descending branch of the left coronary artery on the border of the upper and middle third of the vessel. Therapeutic hypothermia was performed in a cold chamber, 60 minutes long. The local skin temperature of the neck area was maintained at +4 оC, while the rectal and tympanic temperature decreased to + 25 оC. A suspension of allogeneic cryopreserved MSCs of the placenta with a concentration of 1.2 × × 106 cells/ml was administered once intravenously through v. saphena magna. Heart sonography was carried out by means of «Сономед 500» («СПЕКТРОМЕД», Russia) ultrasound scanner in B- and M-mode using a linear sensor 7.5L38 with frequency of 7.5 MHz. Results and discussion. The control group with experimental MI showed significantly suppressed function of the left ventricle (LV). It resulted in decreasing stroke volume (SV) and cardiac output (CO) and on the whole indicated reduced ejection fraction (EF) to 46.04 %, that was 35 % less than the corresponding normal range. According to the values of relative wall thickness (RWT) and left ventricular mass (LVM) on day 7 and day 30 after ligating the left coronary artery, LV remodelling was proceeding via eccentric mode of LV alteration. Therapeutic hypothermia was not able to completely stop the pathophysiological processes associated with coronary ligation. EF was not significantly different from the control group, and was 51.08 ± ± 2.68 %. On day 7 of the experiment, heart remodelling in this group was proceeding according to the normal geometry model, and on day 30 – according to the eccentric model. In spite of the volume overload causing post-infarction extension of the left ventricular cavity, in the group with applying MSCs, on day 7 there was a compensatory increase of the stroke volume, 1.8 times over compared to the group with normal range values and 2.3 over compared to the control group. The ejection fraction was 17 % less than the normal range, but statistically significantly higher than the corresponding indicator of the control group of this observation period. Heart remodelling after applying allogeneic MSCs associated with MI at all stages of observation was proceeding by eccentric LV hypertrophy. Аfter therapeutic hypothermia and applying MSCs associated with experimental myocardial infarction on day 7 and day 30, the group recorded the best values of echo params of LV anatomical structures, indicating no dilatation along with occuring moderate myocardial hypertrophy. The ejection fraction showed the best outcome, i. e. 58.78 %, while LV remodelling was minimal, occurring according to normal heart geometry. Conclusions. Applying echocardiography in rats is a very informative diagnosis method which makes it possible to describe the type of structural and functional remodelling of the myocardium associated infarction at early and late observation stages. The ultrasound study showed that the closest to the normal range was the group of animals exposed to therapeutic hypothermia and MSC transplantation. According to LVM and RWT values, in the rats of that group on day 7 and day 30 of the experiment, LV remodelling was characterized by normal geometry.

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Section: іNtroductionunclassified

“…On the other hand, multicenter studies have proved that therapeutic hypothermia (TH) has neuro-and cardioprotective effects, and it is administered as one of the urgent methods in providing primary health care [5]. Combining TH along with transplanting MSC seems to have good prospects in this regard.…”

Section: іNtroductionmentioning

confidence: 99%

Ultrasound assessment of heart remodelling affected by therapeutic hypothermia and MSC on myocardial infarction model

et al. 2020

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“…Apesar dos poucos estudos experimentais, randomizados e atuais disponíveis acerca deste assunto, os resultados desta pesquisa podem contribuir para a comunidade científica, visto que a HT é um método de tratamento com características promissoras, visando um melhor atendimento e segurança ao público infantil (Rech & Vieira, 2010;Abate, et al, 2021). Dessa forma, o objetivo deste estudo foi realizar uma análise crítica acerca dos resultados do uso da HT em RNs acometidos com EHI, com ênfase nos desfechos de mortalidade e neurodesenvolvimento durante a primeira infância.…”

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Hipotermia terapêutica em recém-nascidos com encefalopatia hipóxico-isquêmica: Uma análise da primeira infância

Puga

Piedade

Caldas

et al. 2023

RSD

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Objetivo: Realizar uma análise crítica acerca dos resultados do uso da hipotermia terapêutica (HT) em recém-nascidos (RNs) acometidos com encefalopatia hipóxico-isquêmica (EHI), com ênfase nos desfechos de mortalidade e neurodesenvolvimento durante a primeira infância. Metodologia: Trata-se de uma revisão sistemática realizada por meio de buscas nas plataformas indexadas: PubMed, Lilacs, Cochrane e BVS, utilizando os descritores em língua inglesa: “effects”, “hypoxic-ischemic encephalopathy” e “induced hypothermia”, separados pelo operador booleano (AND). Foram inclusos artigos de ensaios clínicos completos, nos idiomas português ou inglês, publicados entre os anos de 2012 e 2022, cuja população alvo fosse composta por RNs, de ambos os sexos, diagnosticados com hipóxia neonatal ou EHI, que realizaram o tratamento com HT. Ademais, foram selecionados somente artigos que enfatizaram os desfechos de mortalidade e de neurodenvolvimento no período da alta até a primeira infância. Resultados: O presente estudo contou com a amostra final de 4 artigos. Por meio da análise dos estudos selecionados, percebeu-se que a HT atua por meio de mecanismos de neuroproteção, favorecendo a inibição da cascata inflamatória induzida durante o processo de desenvolvimento da EHI, auxiliando na redução da lesão cerebral e diminuindo, consequentemente, as taxas de morbimortalidade de pacientes acometidos com EHI, contribuindo para o pleno desenvolvimento infantil. Conclusão: O efeito neuroprotetor da HT é capaz de reduzir a presença de sequelas neurológicas e de diminuir as taxas de letalidade na população pediátrica/neonatal acometida pela EHI.

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“…Although there is a breakthrough in the management of cardiac arrest, this event involves high mortality, because even with a cardiopulmonary resuscitation (CPR) of success, the person affected may still present neurological sequelae and risk of death. 1 It estimated that in Brazil occur annually, cardiac arrest 200,000 as one-half of the cases in hospitals, and the other half in Extramural environment. Survival rates related to client with return to spontaneous circulation not yet known despite advances related to prevention and treatment.…”

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Correlation between the post-cardiac arrest care algorithm and the nursing interventions classification (NIC)

Costa

Santos

Silva

2014

R. pesq. cuid. fundam. online

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Objetivo: Correlacionar o algoritmo de cuidados pós-PCR da American Heart Association (AHA) ao sistema de classificação sugerido pela Nursing Interventions Classification (NIC) e suas consequentes atividades de Enfermagem, ambos publicados em 2010. Métodos: Estudo narrativo de revisão de literatura que utilizou como fonte de coleta de dados as referências acima. A coleta de dados foi realizada em julho de 2012. Resultados: Analisou-se o algoritmo de cuidados pós-PCR da AHA 2010 e foram sugeridas classificações e atividades de enfermagem para cada etapa do algoritmo de cuidados. Conclusão: Concluiu-se que a partir da interpretação do algoritmo de cuidados pós-PCR é possível sugerir intervenções de enfermagem, fundamentadas em NIC, para otimizar a assistência de enfermagem prestada ao cliente com retorno à circulação espontânea. Descritores: Parada Cardíaca, Enfermagem, Cuidados de enfermagem

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Hipotermia terapêutica em pacientes pós-parada cardiorrespiratória: mecanismos de ação e desenvolvimento de protocolo assistencial

Abstract: Mild therapeutic hypothermia after cardiac arrest: mechanisms of action and protocol development Hipotermia terapêutica em pacientes pós-parada cardiorrespiratória: mecanismos de ação e desenvolvimento de protocolo assistencial

Cited by 6 publications

References 60 publications

Ultrasound assessment of heart remodelling affected by therapeutic hypothermia and MSC on myocardial infarction model

Ultrasound assessment of heart remodelling affected by therapeutic hypothermia and MSC on myocardial infarction model

Hipotermia terapêutica em recém-nascidos com encefalopatia hipóxico-isquêmica: Uma análise da primeira infância

Correlation between the post-cardiac arrest care algorithm and the nursing interventions classification (NIC)

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