Early achievement of mild therapeutic hypothermia and the neurologic outcome after cardiac arrest

Wolff, Birger; Machill, Klaus; Schumacher, Detlef; Schulzki, Ilona; Werner, Dierk

doi:10.1016/j.ijcard.2007.12.039

Cited by 199 publications

(121 citation statements)

References 26 publications

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“…In einer registerbasierten Fallserie mit 986 komatösen Patienten nach Kreislaufstill-stand war der Zeitpunkt des Kühlungs-beginns nicht mit einem besseren neurologischen Outcome nach Krankenhausentlassung assoziiert [666]. Eine Fallserie mit 49 aufeinanderfolgenden intravaskulär gekühlten komatösen Patienten nach präklinischem Kreislaufstillstand wies ebenfalls nach, dass die Zeit bis zum Erreichen der Zieltemperatur kein unabhängiger Prädiktor für das neurologische Outcome ist [749].…”

Section: Temperaturkontrolleunclassified

Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)

Deakin

Nolan

Soar

et al. 2010

Notfall Rettungsmed

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Section: Temperaturkontrolleunclassified

Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)

Deakin

Nolan

Soar

et al. 2010

Notfall Rettungsmed

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“…Animal studies have demonstrated that hypothermia initiated during or immediately after ROSC is associated with better organ preservation and increased survival. 56,57 Recently, in 49 patients treated with MTH, early achievement of the target temperature was an independent factor for good outcome 58 (GOE V). However, larger trials are warranted to assess the advantage of early vs. late cooling in humans.…”

Section: When and For How Long?mentioning

confidence: 99%

“…In a Swedish study, continuous EEG was used as a predictor of outcome 80 (GOE V). Moreover, biochemical tests such as s-100 and NSE have also been used successfully 81 (GOE II), and in a recent study NSE corelated with time to reach the target temperature 58 (GOE V). The prognostic value of CT and MRI is not known today, but both are recommended if a cerebral cause or complication is suspected.…”

Section: Prognosticationmentioning

confidence: 99%

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Castrèn¹,

Silfvast²,

Rubertsson³

et al. 2009

Acta Anaesthesiol Scand

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Background and aim: Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).Methods: Relevant studies were identified after two consensus meetings of the SSAI Task Force on Therapeutic Hypothermia (SSAITFTH) and via literature search of the Cochrane Central Register of Controlled Trials and Medline. Evidence was assessed and consensus opinion was used when high‐grade evidence (Grade of Recommendation, GOR) was unavailable. A management strategy was developed as a consensus from the evidence and the protocols in the participating countries.Results and conclusion: Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic factors.

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“…In addition, these forced cooling methods and drugs are not readily available on ambulances. Patients must wait minutes or even hours before cooling is initiated in hospital, thus delaying the time for reaching therapeutic hypothermia and reducing the efficacy of cooling (Kuboyama et al, 1993;Wolff et al, 2009).…”

mentioning

confidence: 99%

Induction of a Prolonged Hypothermic State by Drug-induced Reduction in the Thermoregulatory Set-Point

Katz

Frank

McGwin

et al. 2012

Therapeutic Hypothermia and Temperature Management

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Background: The marked improvement in outcome following induction of hypothermia after cardiac arrest has spurred the search for better methods to induce cooling. A regulated decrease in core temperature mediated by a drug-induced reduction in the set point for thermoregulation may be an ideal means of inducing hypothermia. To this end, the exploratory drug HBN-1 was assessed as a means to induce mild and prolonged hypothermia. Methods: Free moving rats were infused i.v. for 12 hours with: a vehicle at room temperature (normothermia), a vehicle chilled to 4°C (forced hypothermia), or HBN-1 (mixture of ethanol, lidocaine, and vasopressin) at room temperature. Core (intra-abdominal) temperature (T c ) was measured telemetrically, tail skin temperature (T tail ) by infrared thermography, metabolic rate (MR) was estimated with indirect calorimetery, and shivering was scored visually. Results: HBN-1 elicited a reduction in T c from 37.5°C to 34°C within 80 minutes after initiation of the infusion; T c was maintained between 33°C and 34°C for more than 13 hours. HBN-1 infusion was associated with a reduction in MR ( p = 0.0006), a slight reduction in T tail , and no evidence of shivering ( p < 0.001). The forced hypothermia group displayed shivering ( p < 0.001), a significant increase in MR, and a decrease in T tail , indicative of peripheral vasoconstriction to reduce heat loss. Conclusion: HBN-1 infusion induced a mild and prolonged hypothermia in free moving, unanesthetized rats characterized by modulation of thermoeffectors to reduce heat gain and increase heat loss. HBN-1 thus appears to elicit regulated hypothermia and may provide a new method for achieving a prolonged state of therapeutic hypothermia.

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Early achievement of mild therapeutic hypothermia and the neurologic outcome after cardiac arrest

Cited by 199 publications

References 26 publications

Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)

Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Induction of a Prolonged Hypothermic State by Drug-induced Reduction in the Thermoregulatory Set-Point

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