Adverse drug reactions in therapeutic hypothermia after cardiac arrest

Abstract

Background: Therapeutic hypothermia (TH) improves survival and neurologic function in comatose survivors of cardiac arrest. Many medications used to support TH have altered pharmacokinetics and pharmacodynamics during this treatment. It is unknown if or at what frequency the medications used during TH cause adverse drug reactions (ADRs). Methods: A retrospective chart review was conducted for patients admitted to an intensive care unit (ICU) after cardiac arrest and treated with TH from January 2009 to June 2012 at two urban, university-affiliated, tertiary-care medical centres. Medications commonly used during TH were screened for association with significant ADRs (grade 3 or greater per Common Terminology Criteria for Adverse Events) using three published ADR detection instruments. Results: A total of 229 patients were included, the majority being males with median age of 62 presenting with an out-of-hospital cardiac arrest in pulseless electrical activity or asystole. The most common comorbidities were hypertension, coronary artery disease, and diabetes mellitus. There were 670 possible ADRs and 69 probable ADRs identified. Of the 670 possible ADRs, propofol, fentanyl, and acetaminophen were the most common drugs associated with ADRs. Whereas fentanyl, insulin, and propofol were the most common drugs associated with a probable ADR. Patients were managed with TH for a median of 22 hours, with 38% of patients surviving to hospital discharge. Conclusions: Patients undergoing TH after cardiac arrest frequently experience possible adverse reactions associated with medications and the corresponding laboratory abnormalities are significant. There is a need for judicious use and close monitoring of drugs in the setting of TH until recommendations for dose adjustments are available to help prevent ADRs.

Outcomes and Adverse Effects With Peramivir for the Treatment of Influenza H1N1 in Critically Ill Pediatric Patients

“…Nonetheless, 3 independent and validated scoring systems were used to strengthen the assessments made in this analysis, which is a suggested method reported in safety and adverse effect analyses. 18,19,28 The use of 3 tools does not mitigate the possibility that they could erroneously agree on the evaluation of an ADR, but this more rigorous approach was applied to increase the robustness of these assessments. Assessment of other agents' causing or contributing to these adverse events was not conducted as the assessment tools account for the presence of other possible contributing factors.…”

“…The use of 3 ADR detection tools has been reported as a more rigorous approach to accurately detect ADRs and was applied in an attempt to overcome limitations of retrospective review. 18,19 Duration of mechanical ventilation (MV), duration of hospital and ICU LOS, and mortality were reported, as well as discharge disposition. All statistics reported were descriptive in nature.…”

Survival and neurological function in patients treated with extracorporeal membrane oxygenation and therapeutic hypothermia: a protocol for updating a systematic review

“…19 Consequently, in the clinical management of ECPR patients, numerous countries have embraced the use of physical and chemical methods, such as surface cold compress technology, intravascular cooling technology, nasal cooling devices and pharmaceutical agents, to swiftly achieve the target core temperature drop within intensive care units. [20][21][22][23][24] Nevertheless, in recent years, the implementation of therapeutic hypothermia in cardiac arrest patients undergoing ECPR has sparked some controversy. Recent studies have indicated that there were no marked differences in survival rates and the likelihood of favourable neurological outcomes between normothermia and hypothermia groups.…”

Untoward Effects in the Practice of Therapeutic Hypothermia: A Literature Update

“…Witcher, et al have recently conducted a retrospective chart review of 229 patients admitted to an intensive care unit after cardiac arrest and treated with TH [75]. There were 670 possible ADRs i.e., an average of 3 for each patient treated with TH-and 69 probable ADRs identified.…”