Mild Resuscitative Hypothermia to Improve Neurological Outcome After Cardiac Arrest

Abstract

Background and Purpose-Recent animal studies showed that mild resuscitative hypothermia improves neurological outcome when applied after cardiac arrest. In a 3-year randomized, prospective, multicenter clinical trial, we hypothesized that mild resuscitative cerebral hypothermia (32°C to 34°C core temperature) would improve neurological outcome after cardiac arrest. Methods-We lowered patients' temperature after admission to the emergency department and continued cooling for at least 24 hours after arrest in conjunction with advanced cardiac life support. The cooling technique chosen was external head and total body cooling with a cooling device in conjunction with a blanket and a mattress. Infrared tympanic thermometry was monitored before a central pulmonary artery thermistor probe was inserted. Results-In

Pharmacological correction of hypothermic P50shift does not alter outcome from focal cerebral ischemia in rats

“…This magnitude of effect is proportionately similar to that previously reported in humans at a variety of moderately hypothermic temperatures (3,5,40). The range of temperatures studied in the current experiments is of particular relevance to current clinical trials utilizing induced hypothermia in either perioperative or intensive care settings (3,12,20,34,36,43). Greater reduction in P 50 would be expected in humans subjected to cardiopulmonary bypass and deep or profound hypothermia (13).…”

“…Although the efficacy of induced hypothermia remains unproven in humans sustaining ischemic brain injury, intense investigation continues with the hope of defining conditions where benefits may be obtained (12,20,34,36,43).…”

Resuscitative Value of B-Type Natriuretic Peptide in Comatose Survivors Treated With Hypothermia After Out-of-Hospital Cardiac Arrest due to Cardiac Causes

“…On the other hand, adverse effects of therapeutic hypothermia include coagulopathy, cardiac dysrhythmias, impaired cardiac function, and increased susceptibility to infection. [14][15][16][17][18][20][21][22][23] The prevalence and severity of those adverse effects is proportional to the depth and duration of cooling. In the present study, a protocol of mild hypothermia was used, with a longer duration of cooling (34°C for 2 days or more, fundamentally for 3 days), because the criteria for induction of hypothermia included comatose survivors after out-of-hospital sudden cardiac arrest from any rhythm, and the procedure of cardiac resuscitation was to use invasive CPR with emergency cardiopulmonary bypass when ROSC could not be achieved by standard CPR.…”

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

“…The use of mild hypothermia after OHCA yielded better outcome, but also more pneumonias after 48-hour hypothermia and very slow re-warming at a rate no greater than 1 °C per day (Yanagawa et al 1998). In a pilot study of the HACAStudy group, external cooling of the head and trunk after ROSC in the emergency department was feasible and safe (Zeiner et al 2000). Felberg et al reported a feasibility trial where external cooling was feasible and safe.…”