An observational study of surface versus endovascular cooling techniques in cardiac arrest patients: a propensity-matched analysis

Oh, Sang Hoon; Oh, Joo Suk; Kim, Young‐Min; Park, Kyu Nam; Choi, Seung Pill; Kim, Gi Woon; Jeung, Kyung Woon; Jang, Tae Chang; Park, Yoo Seok; Kyong, Yeon Young

doi:10.1186/s13054-015-0819-7

Cited by 39 publications

(41 citation statements)

References 37 publications

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“…Two retrospective studies have reported non-significant trends to better neurological outcome associated with endovascular cooling compared to surface cooling. One study found good neurological outcomes of 35.4 versus 25.6 % for endovascular versus surface cooling [46]; another, of 45 versus 38 % [47]. Recently, the results of a prospective multicenter RCT in 400 patients comparing endovascular to basic surface cooling methods have been published [48].…”

Section: Start Temperature Managementmentioning

confidence: 99%

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

2015

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Cardiac arrest is the most common cause of death in North America. Neurocritical care interventions, including targeted temperature management (TTM), have significantly improved neurological outcomes in patients successfully resuscitated from cardiac arrest. Therefore, resuscitation following cardiac arrest was chosen as an emergency neurological life support protocol. Patients remaining comatose following resuscitation from cardiac arrest should be considered for TTM. This protocol will review induction, maintenance, and re-warming phases of TTM, along with management of TTM side effects. Aggressive shivering suppression is necessary with this treatment to ensure the maintenance of a target temperature. Ancillary testing, including electrocardiography, computed tomography and/or magnetic resonance imaging of the brain, continuous electroencephalography monitoring, and correction of electrolyte, blood gas, and hematocrit changes, are also necessary to optimize outcomes.

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Section: Start Temperature Managementmentioning

confidence: 99%

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

2015

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“…None have found statistically significant differences in patient outcomes between different cooling technologies, although some have reported trends in favor of invasive cooling. 11,17,18 Of note, 1 study reported that therapeutic hypothermia in CA patients could be induced and maintained with low-technology methods (refrigerated fluids and ice packs) only, without cooling devices, and that outcomes were comparable to studies using more sophisticated cooling technology.19 However, controlling temperature in this way significantly increases nursing workload, and it is difficult to prevent temperature variation during the maintenance phase and to effectively control rewarming. …”

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confidence: 99%

“…The numbers are similar to those reported in a fairly large (167 patients) retrospective study from Norway, where survival with good neurological outcome was 38% (surface cooling) versus 45% (core cooling), P=0.345. 17 Similarly, a retrospective study using a Korean registry for CA patients compared 559 patients cooled with surface-cooling devices (including Blanketrol, MediTherm, and Arctic Sun) with 244 patients cooled with endovascular catheters 18 ; good neurological outcome was 25.6% for surface cooling versus 35.4% for endovascular cooling (P=0.01). 18 However, the groups were not well matched; after propensity score matching in 360 patients (180 in each group), rates of favorable neurological outcome were 30% for surface cooling versus 35% for endovascular cooling (P=0.31).…”

mentioning

confidence: 99%

“…17 Similarly, a retrospective study using a Korean registry for CA patients compared 559 patients cooled with surface-cooling devices (including Blanketrol, MediTherm, and Arctic Sun) with 244 patients cooled with endovascular catheters 18 ; good neurological outcome was 25.6% for surface cooling versus 35.4% for endovascular cooling (P=0.01). 18 However, the groups were not well matched; after propensity score matching in 360 patients (180 in each group), rates of favorable neurological outcome were 30% for surface cooling versus 35% for endovascular cooling (P=0.31). As in the study by Deye et al, the risk of overcooling was greater in the surface-cooling group (17.8% versus 7.8%, P=0.01 after propensity score matching).…”

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confidence: 99%

“…There was also a higher risk of rebound hyperthermia (13.5% versus 5.9%, P=0.02) and other adverse events during rewarming in patients treated with surface cooling. 18 When these studies and the robust prospective trial by Deye et al are examined, the data suggest (although they do not conclusively prove) that a quicker induction with less overshoot and (probably of greater importance) more stable temperature maintenance and better control during rewarming may improve neurological outcomes. Although the outcome data did not reach statistical significance, the technical data on cooling success are clinically relevant, and potentially useful to clinicians seeking information on the efficacy of cooling technologies (and on temperature management without using a cooling device), regardless of which temperature is targeted.…”

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confidence: 99%

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How to Stay Cool in the Intensive Care Unit?

Polderman

2015

Circulation

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A B Figure. A (adapted from 11 ), Temperature management with set target of 32°C. For the induction phase, the aim is to get temperature to <34°C and down to the target temperature as quickly as possible. A small overshoot (≤1°C) should be regarded as acceptable provided temperature remains >30°C. For the maintenance phase, the target is tight control of core temperature, with minimal fluctuations (ideally never >0.3°C). The rewarming phase should be slow and controlled (warming rate 0.2°C-0.25°C/h). B, Temperature management with set target of 36°C. For the induction phase, the aim is to get the temperature to 36.0°C as quickly as possible. For the maintenance phase, the target is tight control of core temperature, with minimal fluctuations (ideally never >0.2°C-0.3°C). More shivering is likely, because the target temperature is closer to normal, leading to an enhanced shivering response. There is greater risk of slipping into a supranormal (febrile) temperature range, especially because brain temperature exceeds core temperature by 1.0°C to 2.0°C at this temperature. temp indicates temperature; and TTM, therapeutic temperature management. (attributable to decreased consciousness and diminished protective reflexes), brain injury can directly induce immune dysfunction (mediated through the vagal nerve, with efferent signals inhibiting proinflammatory cytokine production), leading to an immunocompromised state with increased susceptibility to infections. 14 Therefore, patients with acute brain injury may have central fever, infectious fever, or a combination of both, either simultaneously or sequentially. Whatever the cause, the result is that the temperature set point is elevated, triggering the body's mechanisms to increase core temperature, and that the patient develops fever.The effectiveness of heat conservation and heat generation decreases with age; this is attributable to a less effective vascular response (ie, less vasoconstriction), decreased ability to detect small temperature changes (leading to a slower counterregulatory response), and a lower basal metabolic rate.11 This means that, in general, fever control and the induction of hypothermia are easier to achieve and maintain in older patients than in younger ones. In addition, the doses of opiates and sedatives required to effectively suppress the body's warming mechanisms are usually much higher in younger patients. Another important parameter affecting ease and speed of cooling is body mass; obese patients are more difficult to cool, especially with surface cooling, because of the insulating properties of adipose tissue and the greater mass that needs to be cooled.Finally, an issue that often confounds studies dealing with (efficacy of) temperature management is that severe brain injury can significantly diminish or even obviate the thermoregulatory response; it is therefore much easier to cool patients with very severe brain injury (and absent shivering response) than those with less severe injury. Thus, easy temperature control is, paradoxically...

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Praxisleitfaden für die Postreanimationsbehandlung

Storm

Behringer

Wolfrum

et al. 2019

Med Klin Intensivmed Notfmed

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Abb. 1 8 Darstellung des strukturierten Ablaufs der Versorgung nach Herz-Kreislauf-Stillstand. CA "cardiac arrest", CPR "cardiopulmoary resuscitation", ROSC "return of spontaneous circulation", PCI "percutaneous intervention", TTM "targeted temperature management", CT Computertomographie, EEG Elektroenzephalographie, SSEP somatosensorisch evozierte Potenziale, MRT Magnetresonanztomographie, WLST "withdrawal of life-sustaining treatment", CPC "cerebral performance category" (CPC 1 "good cerebral performance", CPC 2 "moderate cerebral performance", CPC3 "severe cerebral disability", CPC4 "comatose or unresponsive wakefullness syndrome", CPC5 "brain death or dead")

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An observational study of surface versus endovascular cooling techniques in cardiac arrest patients: a propensity-matched analysis

Cited by 39 publications

References 37 publications

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

Emergency Neurological Life Support: Resuscitation Following Cardiac Arrest

How to Stay Cool in the Intensive Care Unit?

Praxisleitfaden für die Postreanimationsbehandlung

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