Physiologic effects of hypothermia

Kovács, Enikő; Jenei, Zsigmond; Horváth, Anikó; Gellér, László; Szilágyi, Szabolcs; Király, Ákos; Molnár, Levente; Sótonyi, Péter; Merkely, Béla; Zima, Endre

doi:10.1556/oh.2011.29006

Cited by 8 publications

(4 citation statements)

References 48 publications

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“…Targeted temperature management and therapeutic hypothermia may also affect hemodynamic variables of post-cardiac arrest patients in a negative manner: bradycardia, decrease in cardiac output and increase in systemic vascular resistance can evolve [58,59]. As a consequence of lower temperature primarily during induction phase polyuria may occur resulting in hypovolemia [60].…”

Section: Discussionmentioning

confidence: 99%

Strategies of Neuroprotection after Successful Resuscitation

Kovács¹,

Zima²

2017

Resuscitation Aspects

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Post-cardiac arrest syndrome (PCAS) incorporates post-cardiac arrest brain injury, postcardiac arrest myocardial dysfunction, systemic ischemia/reperfusion syndrome and the precipitating pathology. Brain injury remains the leading cause of death in the postcardiac arrest period. One of our main goals during post-resuscitation care is to guide a proper neuroprotective strategy. We are going to summarize the tools of neuroprotection in post-cardiac arrest therapy. The role of normoxia/normocapnia, normoglycemia, seizure control, sedation and pharmacologic strategies will be discussed in brief. The handling of temperature management and the management of hemodynamic variables to secure satisfactory cerebral perfusion will be worked out in details. Targeted temperature management is the main tool of neuroprotection in post-cardiac arrest therapy. We are going to conclude the principles of temperature control after successful resuscitation pointing out its beneficial effects. This method has also several complications that are going to be discussed highlighting its hemodynamic impacts. There is no evidence about target hemodynamic parameters during post-cardiac arrest syndrome to maintain cerebral perfusion neither about the most effective hemodynamic monitoring system. We are presenting preliminary data of our study where we investigate the effect of PiCCO™ (Pulse index Continous Cardiac Output) monitoring on the outcome in this patient group.Keywords: post-cardiac arrest syndrome, post-cardiac arrest brain injury, post-resuscitation therapy, targeted temperature management, hemodynamic parameters IntroductionSudden cardiac arrest is one of the leading causes of death in Europe [1]. The outcome is still very poor: the hospital discharge varies between 7 and 10% after out-of-hospital cardiac arrest (OHCA) and it is approximately 25% after in-hospital cardiac arrest (IHCA) [1]. The chain of © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.survival describes links that lead to a successful resuscitation [2]. The fourth element covers proper post-resuscitation care to restore quality of life. It is well known that the management of post-resuscitation cardiac arrest syndrome affects outcome and it is an important part of the resuscitation process. Pointing out the growing importance of post-resuscitation therapy, the European Resuscitation Council (ERC) introduced a separate chapter about post-resuscitation care in the 2015 guidelines [3]. One of the key elements to improve survival rate after sudden cardiac arrest may be the enhancement of post-resuscitation therapy.The post-cardiac arrest brain injury remains the main cause of mortality in the post-cardiac arrest period, being as high as 68% after OHCA and 25% after IHCA [4]. These data show that one of our leading goa...

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Section: Discussionmentioning

confidence: 99%

Strategies of Neuroprotection after Successful Resuscitation

Kovács¹,

Zima²

2017

Resuscitation Aspects

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“…On the one hand, target temperature management (TTM) with target temperature of 32–36 °C is applied as a neuroprotective tool in comatose patients surviving cardiac arrest [ 6 , 7 , 8 ]. On the other hand, TTM and particularly mild hypothermia may influence the circulatory system in a negative manner leading to bradycardia, arrhythmias, increased systemic vascular resistance, polyuria, and corresponding hypovolemia [ 9 , 10 ]. Post-cardiac arrest syndrome has also a plenty of factors affecting the hemodynamics harmfully [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation

Kovács

Gyarmathy

Pilecky

et al. 2021

IJERPH

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Proper hemodynamic management is necessary among post-cardiac arrest patients to improve survival. We aimed to investigate the effects of PiCCO™-guided (pulse index contour cardiac output) hemodynamic management on mortality in post-resuscitation therapy. In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32–34 °C, 33 patients received PiCCO™, and 30 were not monitored with PiCCO™. Primary and secondary outcomes were 30 day and 1 year mortality. Kaplan–Meier curves and log-rank tests were used to assess differences in mortality among the groups. Interaction effects to disentangle the relationship between patient’s condition, PiCCO™ application, and mortality were assessed by means of Chi-square tests and logistic regression models. A 30 day mortality was significantly higher among PiCCO™ patients, while 1 year mortality was marginally higher. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device, or without stroke in prior history) had worse outcomes with PiCCO™-guided therapy. Catecholamine administration worsened both 30 day and 1 year mortality among all patients. Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients’ condition, and 30 day mortality for most conditions.

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“…[3][4][5] On the other hand, TTM may in uence circulatory system in a negative manner leading to bradycardia, arrhytmias, increased systemic vascular resistance and hypovolaemia. 6,7 Post-cardiac arrest syndrome has also a plenty of factors affecting the hemodynamics harmfully. 1 Moreover, a proper hemodynamic management is crucial to keep a satisfactory cerebral perfusion to prevent further cerebral deterioration.…”

Section: Introductionmentioning

confidence: 99%

An interaction effect analysis of thermodilution-guided hemodynamic optimization, patient condition, and mortality among successful cardiopulmonary resuscitation patients

Kovács

Gyarmathy²,

Pilecky

et al. 2020

Preprint

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Background Post-cardiac arrest syndrome and target temperature management have an influence on hemodynamics in a complex way. Proper hemodynamic monitoring is necessary among post-cardiac arrest patients. The aim of our study was to investigate the effects of PiCCO™-guided hemodynamic management on short- and long-term mortality in post-resuscitation therapy and to disentangle the relationship between PiCCO™-application, the patients' condition, and mortality by assessing it as an interaction effect. Methods In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32–34˚C, 30 patients received no PiCCO™ monitor application and 33 received PiCCO™. Primary and secondary outcomes were 30-day and one-year mortality. Kaplan-Meyer curves and corresponding Log-rank tests were used to assess differences in mortality among PiCCO™ vs non-PiCCO™ patients. Interaction effects (patient`s condition vs. PiCCO™ application vs. mortality) were assessed by means of Chi-square tests and logistic regression models. Results 30-day mortality was significantly, and one-year mortality was marginally higher among PiCCO™ patients. We found five interaction patterns between patients’ condition and being monitored with PiCCO™ with regard to mortality after 30 days, which distilled down to three interaction patterns by the end of the first year. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Moreover, patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device or without stroke in prior history) had worse outcomes in PiCCO™-guided therapy. Furthermore, catecholamine administration worsened both 30-day and one-year mortality among all patients. Conclusions Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients’ condition, and 30-day mortality for most conditions. Furthermore, in terms of one-year mortality, there was either no benefit whatsoever of PiCCO™ monitoring on survival or there was worse survival among patients who had no underlying conditions but received PiCCO™ (such as among patients who had no STEMI or had no stroke).

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Physiologic effects of hypothermia

Cited by 8 publications

References 48 publications

Strategies of Neuroprotection after Successful Resuscitation

Strategies of Neuroprotection after Successful Resuscitation

An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation

An interaction effect analysis of thermodilution-guided hemodynamic optimization, patient condition, and mortality among successful cardiopulmonary resuscitation patients

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