Effects of pre-arrest and intra-arrest hypothermia on ventricular fibrillation and resuscitation

Menegazzi, James J.; Rittenberger, Jon C.; Suffoletto, Brian; Logue, Eric S.; Salcido, David D; Reynolds, Joshua C.; Sherman, Lawrence

doi:10.1016/j.resuscitation.2008.09.002

Cited by 33 publications

(30 citation statements)

References 26 publications

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“…Others have also shown a reduction in the electric threshold for successful defibrillation during hypothermic resuscitation 30,31 and an improvement in the ROSC rate. 32 A possible explanation for the failure in the present study to see an improvement in ROSC may be the fact that in our study design, we did not specify exactly when cooling needed to be initiated, for fear of interfering with the resuscitation routine. Therefore, intra-arrest cooling was initiated relatively late during the resuscitation protocol after several shocks had been delivered, a good 15 minutes into CPR, after intravenous access was established, epinephrine had been administered, and endotracheal intubation had been performed.…”

Section: Castrén Et Al Prehospital Intra-arrest Transnasal Coolingmentioning

confidence: 80%

Intra-Arrest Transnasal Evaporative Cooling

et al. 2010

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Background-Transnasal evaporative cooling has sufficient heat transfer capacity for effective intra-arrest cooling and improves survival in swine. The aim of this study was to determine the safety, feasibility, and cooling efficacy of prehospital transnasal cooling in humans and to explore its effects on neurologically intact survival to hospital discharge. Methods and Results-Witnessed cardiac arrest patients with a treatment interval Յ20 minutes were randomized to intra-arrest cooling with a RhinoChill device (treatment group, nϭ96) versus standard care (control group, nϭ104). The final analysis included 93 versus 101 patients, respectively. Both groups were cooled after hospital arrival. The patients had similar demographics, initial rhythms, rates of bystander cardiopulmonary resuscitation, and intervals to cardiopulmonary resuscitation and arrival of advanced life support personnel. Eighteen device-related adverse events (1 periorbital emphysema, 3 epistaxis, 1 perioral bleed, and 13 nasal discolorations) were reported. Time to target temperature of 34°C was shorter in the treatment group for both tympanic (102 versus 282 minutes, Pϭ0.03) and core (155 versus 284 minutes, Pϭ0.13) temperature. There were no significant differences in rates of return of spontaneous circulation between the groups (38% in treated subjects versus 43% in control subjects, Pϭ0.48), in overall survival of those admitted alive (44% versus 31%, respectively, Pϭ0.26), or in neurologically intact survival to discharge (Pittsburgh cerebral performance category scale 1 to 2, 34% versus 21%, Pϭ0.21), although the study was not adequately powered to detect changes in these outcomes. Conclusions-Prehospital

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Section: Castrén Et Al Prehospital Intra-arrest Transnasal Coolingmentioning

confidence: 80%

Intra-Arrest Transnasal Evaporative Cooling

et al. 2010

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“…Animal studies have suggested that early cooling improves ROSC and outcomes. 6,8 Based on the premise of time sensitivity of cooling for neuroprotection, many EMS systems have adopted prehospital TH induction to expedite cooling. Prehospital induction via 4uC normal saline is feasible, safe, and effective in decreasing core temperature.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 The optimal timing of therapeutic cooling remains unclear. Animal models have demonstrated that immediate and faster cooling yields improved outcomes, [6][7][8] but other studies have suggested that no benefit exists in short-term survival with rapid cooling, even when compared to normothermic postresuscitation care. 8 Observational human studies, although limited by their design, have also yielded conflicting results, with rapid cooling reported to be associated with improved, neutral, and negative effects on neurologic status and mortality.…”

Section: Ré Sumémentioning

confidence: 99%

“…Animal models have demonstrated that immediate and faster cooling yields improved outcomes, [6][7][8] but other studies have suggested that no benefit exists in short-term survival with rapid cooling, even when compared to normothermic postresuscitation care. 8 Observational human studies, although limited by their design, have also yielded conflicting results, with rapid cooling reported to be associated with improved, neutral, and negative effects on neurologic status and mortality. [9][10][11][12][13][14][15] Despite the lack of clear evidence, many prehospital systems have implemented prehospital cooling protocols for post-cardiac arrest patients who remain comatose in the field.…”

Section: Ré Sumémentioning

confidence: 99%

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Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature

Schenfeld

Studnek²,

Heffner

et al. 2015

CJEM

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Objective: Despite growing adoption, the impact of prehospital initiation of therapeutic hypothermia on outcomes of cardiac arrest patients is unknown. The objective of this study was to determine if prehospital administration of cold intravenous fluids improved the time-to-target temperature. Methods: All patients enrolled in an institutional postcardiac arrest treatment pathway were prospectively registered into a quality assurance database. Patients undergoing cooling induction on hospital arrival were compared to those receiving a new treatment protocol initiated during the study period involving prehospital cooling with 4uC (39.2uF) normal saline. The primary outcome was the time-to-target temperature. Secondary outcomes included emergency medicine system transport time metrics, mortality, and neurologic status at discharge and 1 year. Results: One hundred thirty-two patients were enrolled during the study period. The initial rhythm was ventricular fibrillation/tachycardia in 63% and asystole/pulseless electrical activity in 36%. Eighty patients received prehospital cooling and 52 patients did not and comprised the historical control group. Time-to-target temperatures were not significantly different between prehospital and hospital cooled groups (256 v. 271 minutes, respectively, p 5 0.64), nor was there any improvement in hospital survival (54% v. 50%, p 5 0.67), good neurologic outcome (49% v. 44%, p 5 0.61), or 1-year survival (49% v. 42%, p 5 0.46) between the two groups. Transport times were longer in the prehospital cooled group. Conclusions: Out-of-hospital cardiac arrest patients treated with prehospital cooling before arrival at our urban hospital did not have faster time-to-target temperature or improvement in outcomes compared to patients cooled immediately on emergency department arrival. Further research is needed to determine if any benefits exist from prehospital cooling prior to its widespread adoption. RÉ SUMÉObjectif: Bien que l'amorce de l'hypothermie thé rapeutique en phase pré hospitaliè re soit de plus en plus ré pandue, on n'en connaît pas l'effet sur les ré sultats, chez les patients victimes d'un arrê t cardiaque. L'é tude visait à dé terminer si l'administration intraveineuse de liquides froids, en phase pré hospitaliè re, permettait d'atteindre plus rapidement la tempé rature cible. Mé thode: Tous les patients soumis à un parcours de traitement, en é tablissement, pour un arrê t cardiaque ont é té inscrits de maniè re prospective dans une base de donné es sur l'assurance de la qualité. Les patients soumis au refroidissement à leur arrivé e à l'hô pital ont é té comparé s avec ceux soumis au nouveau protocole de traitement mis en oeuvre durant la pé riode à l'é tude, comportant un refroidissement pré hospitalier à l'aide de l'administration d'une solution physiologique salé e maintenue à 4uC (39.2uF). Le principal critè re d'é valuation é tait le temps né cessaire à l'atteinte de la tempé rature cible. Les critè res d'é valuation secondaires comprenaient les mesures du tem...

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“…Animal studies that induced intra-arrest or prearrest hypothermia with cooling at approximately the same time as defibrillation and CPR reported improved defibrillation or ROSC [8][9][10][11][12][13][14]. However, only a few studies have reported the effects of preexisting hypothermia on resuscitation and myocardial function.…”

Section: Introductionmentioning

confidence: 99%

Prearrest hypothermia improved defibrillation and cardiac function in a rabbit ventricular fibrillation model

Jiang

Wang

et al. 2015

The American Journal of Emergency Medicine

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Effects of pre-arrest and intra-arrest hypothermia on ventricular fibrillation and resuscitation

Abstract: Background-Hypothermia has been shown to improve survival and neurological outcomes for ventricular fibrillation (VF) cardiac arrest. The electrophysiological mechanisms of hypothermia are not well-understood, nor are the effects of beginning cooling during the resuscitation.

Cited by 33 publications

References 26 publications

Intra-Arrest Transnasal Evaporative Cooling

Intra-Arrest Transnasal Evaporative Cooling

Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature

Prearrest hypothermia improved defibrillation and cardiac function in a rabbit ventricular fibrillation model

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