Automated peritoneal lavage: an extremely rapid and safe way to induce hypothermia in post-resuscitation patients

Waard, Monique C. de; Biermann, H.; Brinckman, Stijn L.; Appelman, Yolande; Driessen, Ronald H.; Polderman, Kees H.; Girbes, Armand R. J.; Beishuizen, Albertus

doi:10.1186/cc12518

Cited by 28 publications

(17 citation statements)

References 26 publications

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“…When applying external cooling methods, freezing-induced skin damage and shivering need continuous attention 16. Invasive cooling can be achieved by peritoneal17 or gastric lavage with cold sterile fluids or intravenous cooling via rapid infusion of iced isotonic fluid. The latter is safe, easy and inexpensive to induce cooling.…”

Section: Discussionmentioning

confidence: 99%

Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation

et al. 2014

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Background and objective Mild therapeutic hypothermia (MTH) is used to limit neurological injury and improve survival after cardiac arrest (CA) and cardiopulmonary resuscitation, but the optimal mode of cooling is controversial. We therefore compared the effectiveness of MTH using invasive intravascular or noninvasive surface cooling with temperature feedback control. Methods This retrospective study in post-CA patients studied the effects of intravascular cooling (CoolGard, Zoll, n=97), applied on the intensive care unit (ICU) in one university hospital compared with those of surface cooling (Medi-Therm, Gaymar, n=76) applied in another university hospital. Results Time to reach target temperature and cooling speeds did not differ between groups. During the maintenance phase, mean core temperature was 33.1°C (range 32.7-33.7°C) versus 32.5°C (range 31.7-33.4°C) at targets of 33.0 and 32.5°C in intravascularly versus surface cooled patients, respectively. The variation coefficient for temperature during maintenance was higher in the surface than the intravascular cooling group (mean 0.85% vs 0.35%, p<0.0001). ICU survival was 60% and 50% in the intravascularly and surface cooled groups, respectively (NS). Lower age (OR 0.95; 95% CI 0.93 to 0.98; p<0.0001), ventricular fibrillation/ ventricular tachycardia as presenting rhythm (OR 7.6; 95% CI 1.8 to 8.9; p<0.0001) and lower mean temperature during the maintenance phase (OR 0.52; 95% CI 0.25 to 1.08; p=0.081) might be independent determinants of ICU survival, while cooling technique and temperature variability did not contribute. Conclusions In post-CA patients, intravascular cooling systems result in equal cooling speed, but less variation in temperature during the maintenance phase, as surface cooling. This may not affect the outcome.

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Section: Discussionmentioning

confidence: 99%

Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation

et al. 2014

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“…A small observational study reported that peritoneal hypothermia in patients with STEMI and cardiac arrest is feasible and results in rapid cooling. 14 We therefore performed a multicenter randomized trial to assess the feasibility, safety, and efficacy of peritoneal hypothermia to reduce infarct size in patients with acute STEMI.…”

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confidence: 99%

Prospective, Multicenter, Randomized, Controlled Pilot Trial of Peritoneal Hypothermia in Patients With ST-Segment— Elevation Myocardial Infarction

Nichol

Strickland

Shavelle

et al. 2015

Circ: Cardiovascular Interventions

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Multiple methods to establish hypothermia have been explored. Hypothermia via external surface cooling or infusion of chilled intravenous fluid is limited by a slow rate of induction, temperature instability, and volume overload. Endovascular catheter-based cooling may induce hypothermia more quickly (4.8±2.1°C/h), 5,6,9,12 but still not fast enough toBackground-Systemic hypothermia may reduce infarct size if established before reperfusion. The large surface area of the bowel may facilitate rapid hypothermia. We therefore examined the feasibility, safety, and efficacy of hypothermia induced by an automated peritoneal lavage system in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-Patients with ST-segment-elevation myocardial infarction within 6 hours of symptom onset were randomized to peritoneal hypothermia before and for 3 hours after percutaneous coronary intervention versus control. The primary safety end point was the 30-day composite rate of death, reinfarction, ischemia-driven target vessel revascularization, major bleeding, sepsis, pneumonia, peritonitis, severe arrhythmia, or renal failure. The primary efficacy end point was infarct size assessed by cardiac MRI on day 3 to 5. Fifty-four patients were randomized at 7 centers to hypothermia (n=28) versus control (n=26

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“…Two Class III studies compared different invasive vs superficial cooling methods. 29,30 An additional Class III study 31 investigated the effect of a standardized treatment protocol. Because single Class III studies cannot drive recommendations, details of these studies are discussed only in the complete guideline.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation

et al. 2017

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Objective: To assess the evidence and make evidence-based recommendations for acute interventions to reduce brain injury in adult patients who are comatose after successful cardiopulmonary resuscitation.Methods: Published literature from 1966 to August 29, 2016, was reviewed with evidencebased classification of relevant articles. Results and recommendations:For patients who are comatose in whom the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32-348C for 24 hours) is highly likely to be effective in improving functional neurologic outcome and survival compared with non-TH and should be offered (Level A). For patients who are comatose in whom the initial cardiac rhythm is either VT/VF or asystole/pulseless electrical activity (PEA) after OHCA, targeted temperature management (368C for 24 hours, followed by 8 hours of rewarming to 378C, and temperature maintenance below 37.58C until 72 hours) is likely as effective as TH and is an acceptable alternative (Level B). For patients who are comatose with an initial rhythm of PEA/asystole, TH possibly improves survival and functional neurologic outcome at discharge vs standard care and may be offered (Level C). Prehospital cooling as an adjunct to TH is highly likely to be ineffective in further improving neurologic outcome and survival and should not be offered (Level A). Other pharmacologic and nonpharmacologic strategies (applied with or without concomitant TH) are also reviewed. Neurology ® 2017;88:2141-2149 GLOSSARY AAN 5 American Academy of Neurology; AE 5 adverse event; CI 5 confidence interval; CPC 5 Cerebral Performance Category; CPR 5 cardiopulmonary resuscitation; ECMO 5 extracorporeal membrane oxygenation; HF 5 hemofiltration; IHCA 5 in-hospital cardiac arrest; OHCA 5 out-of-hospital cardiac arrest; PEA 5 pulseless electrical activity; RD 5 risk difference; ROSC 5 return of spontaneous circulation; TH 5 therapeutic hypothermia; TTM 5 targeted temperature management; VT 5 ventricular tachycardia; VF 5 ventricular fibrillation.Outcomes for patients after nontraumatic cardiac arrest are dismal. Only 6%-9.6% of all patients with out-of-hospital cardiac arrest (OHCA) survive to hospital discharge, 1,2 and an estimated 22.3% of patients with in-hospital cardiac arrest (IHCA) survive to hospital discharge.3 Brain injury related to cardiac arrest is a major determinant of mortality and disability.

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Automated peritoneal lavage: an extremely rapid and safe way to induce hypothermia in post-resuscitation patients

Cited by 28 publications

References 26 publications

Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation

Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation

Prospective, Multicenter, Randomized, Controlled Pilot Trial of Peritoneal Hypothermia in Patients With ST-Segment— Elevation Myocardial Infarction

Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation

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