Neurological Benefit of Therapeutic Hypothermia Following Return of Spontaneous Circulation for Out-of-Hospital Non-Shockable Cardiac Arrest

Soga, Taketomo; Nagao, Ken; Sawano, Hirotaka; Yokoyama, Hiroyuki; Terada, Yoshio; Hase, Mamoru; Otani, Takayuki; Shirai, Shinichi; Hara, Hiroshi; Arimoto, Hideki; Kashiwase, Kazunori; Kasaoka, Shunji; Motomura, Tomokazu; Kuroda, Yasuhiro; Yasuga, Yuji; Yonemoto, Naohiro; Nonogi, Hiroshi

doi:10.1253/circj.cj-12-0448

Cited by 45 publications

(30 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our analysis of this subgroup is limited because we do not have information about whether these patients received epinephrine or further defibrillation or how long the resuscitation effort was continued after hospital arrival. Fifth, details on post-cardiac arrest care [3][4][5][6][7][8][9]24,[29][30][31][32][33] and use of extracorporeal cardiopulmonary resuscitation [34][35][36] were lacking. With broader adoption of these treatments, optimum length of the prehospital recitation efforts may need to be extended.…”

Section: Discussionmentioning

confidence: 99%

Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background— During out-of-hospital cardiac arrest, it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. Methods and Results— Between 2005 and 2012, we enrolled 282 183 adult patients with bystander-witnessed out-of-hospital cardiac arrest from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation in cases achieving prehospital return of spontaneous circulation or from call receipt to hospital arrival in cases not achieving prehospital return of spontaneous circulation. In each of 4 groups stratified by initial cardiac arrest rhythm (shockable versus nonshockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve ≥99% sensitivity for the primary end point, favorable 30-day neurological outcome after out-of-hospital cardiac arrest. Prehospital resuscitation duration to achieve prehospital return of spontaneous circulation ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the likelihood of favorable neurological outcome (adjusted odds ratio, 0.84; 95% confidence interval, 0.838–0.844). Although the frequency of favorable neurological outcome was significantly different among the 4 groups, ranging from 20.0% (shockable/bystander resuscitation group) to 0.9% (nonshockable/bystander resuscitation group; P <0.001), minimum prehospital resuscitation duration did not differ widely among the 4 groups (40 minutes in the shockable/bystander resuscitation group and the shockable/no bystander resuscitation group, 44 minutes in the nonshockable/bystander resuscitation group, and 45 minutes in the nonshockable/no bystander resuscitation group). Conclusions— On the basis of time intervals from the shockable arrest groups, prehospital resuscitation efforts should be continued for at least 40 minutes in all adults with bystander-witnessed out-of-hospital cardiac arrest. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/ . Unique identifier: 000009918.

show abstract

Section: Discussionmentioning

confidence: 99%

Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some studies cited comparisons between nSR and VT/VF with respect to the efficacy of TH/ /TTM as major findings [7, 16, 18, 20, 24-28, 30-33, 35, 44]. One trial concluded that if ROSC was < 16 min, TH benefitted OHCA due to nSR similarly to VT/VF (p = 0.84) [16]. The effect of time down during arrest also was described in another trial with a cutoff noted at 10 min for improved outcomes [32].…”

Section: Outcome Variablesmentioning

confidence: 99%

“…The difficulty with measuring outcomes in OHCA due to nSR is that they are more likely to have many of these features, particularly when compared to VT/VF [7,12,16,18,24,25,45,47]. Also, each clinical variable may not alter outcomes in a similar fashion in VT/VF and nSR groups [32,34].…”

Section: Outcome Variablesmentioning

confidence: 99%

“…However, many that did this demonstrated baseline differences that would favor survival in the control group, which could have confounded the results and therefore one cannot make significant conclusions from their findings [11,12,16,19,21,26,28,47]. Nevertheless, evaluating outcome measures in those presenting in nSR, without comparing them to those with VT/ /VF, should be replicated in future studies.…”

Section: Outcome Variablesmentioning

confidence: 99%

See 1 more Smart Citation

A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms

Freund

Kaplan

2017

Cardiol J.

View full text Add to dashboard Cite

show abstract

“…Following landmark studies of therapeutic hypothermia in 2002 2, 3 and TTM in 2013, 4 the focus of neurocritical care management in PCAS has been on targeted values for TTM, including body temperature targets and duration of temperature management. 5, 6 By contrast, there has been little discussion on the monitoring and targeting values for cerebral and systemic parameters. In addition, little research has been done to clarify the neurologic indications for TTM to produce a favorable neuro-with OHCA treated with therapeutic hypothermia.…”

mentioning

confidence: 99%

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima

Hifumi

Kawakita

et al. 2017

Circ J

Self Cite

View full text Add to dashboard Cite

The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.

show abstract

Neurological Benefit of Therapeutic Hypothermia Following Return of Spontaneous Circulation for Out-of-Hospital Non-Shockable Cardiac Arrest

Cited by 45 publications

References 21 publications

Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest

Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest

A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Contact Info

Product

Resources

About