Managing the Complications of Mild Therapeutic Hypothermia in the Cardiac Arrest Patient

Abstract

Mild therapeutic hypothermia (MTH) is used to lower the core body temperature of cardiac arrest (CA) patients to 32°C from 34°C to provide improved survival and neurologic outcomes after resuscitation from in-hospital or out-of-hospital CA. Despite the improved benefits of MTH, there are potentially unforeseen complications associated during management. Although the adverse effects are transient, the clinician should be aware of the associated complications when managing the patient receiving MTH. We aim to provide the medical community comprehensive information related to the potential complications of survivors of CA receiving MTH, as it is imperative for the clinician to understand the physiologic changes that take place in the patient receiving MTH and how to prepare for them and manage them if they do occur. We hope to provide information of how to manage these potential complications through both a review of the current literature and a reflection of our own experience.

RNA binding motif protein 3: a potential biomarker in cancer and therapeutic target in neuroprotection

“…In neurodegenerative diseases and brain injury models, high RBM3 expression is also involved in neuroprotection. hypothermia-mediated neuroprotection has been successfully applied in the clinic for neuroprotection following cardiac arrest [86, 87], stroke [88] and traumatic brain injury [89, 90], but the procedure is associated with complications (cardiovascular effects and metabolic and electrolyte changes) [91]. For example, long-term hypothermia-mediated neuroprotection is a risk in the treatment of psychiatric patients with organic brain damage and may increase hypothermia susceptibility to antipsychotics [92].…”

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

“…On the other hand, a sample of patients undergoing prolonged TH has been shown to exhibit a significantly lower rate of infection in the hypothermia group compared to controls [34]. Culture of the bodily fluid, use of prophylactic antibiotics, and removal of unnecessary catheters may decrease the incidence of infection [24].…”

“…It is of utmost importance to ensure proper mixed venous oxygenation to provide necessary hemodynamic support. Indeed, TH may provide beneficial effects in patients with cardiogenic shock, as the profound bradycardia may act as a beta-blockade to reduce work and therefore oxygen demand of the heart [24].…”

“…Skin warming and intermittent administration of IV meperidine 25 to 75 mg can help achieve adequate suppression of shivering. Likewise, IV magnesium sulfate 2 mg, IV dexmedetomidine 0.2 to 1.5 mg/kg/h, IV propofol, and IV vecuronium 0.1 mg/kg attenuate shivering [24].…”

Controversies in the temperature management of critically ill patients

“…The overall rate of these adverse events was reported to be approximately 70 %. However, because these complications were generally reported to be mild and transient, the benefits of therapeutic hypothermia outweigh these adverse effects [20].…”