Rhabdomyolysis following therapeutic hypothermia after traumatic cardiac arrest

Ciapetti, Marco; Valvasone, S Di; Spina, Rosario; Peris, Adriano

doi:10.1016/j.resuscitation.2010.10.032

Cited by 8 publications

(3 citation statements)

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“…6 Rarely, it has been reported in the literature as a consequence of severe shivering due to both unintentional and therapeutic hypothermia. [7][8][9][10][11][12] This patient's CK improvement with cisatracurium indicated shivering as the most likely cause of his rhabdomyolysis.…”

Section: Discussionmentioning

confidence: 99%

Severe Shivering on Venoarterial Extracorporeal Membrane Oxygenation—Raising the Circuit Temperature to Stop Rhabdomyolysis: A Case Report

et al. 2020

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We report a case of severe shivering resulting in rhabdomyolysis while on venoarterial extracorporeal membrane oxygenation (ECMO) that resolved after hyperthermia was induced using the ECMO circuit. The patient developed shivering approximately 24 hours after venoarterial ECMO cannulation for refractory ventricular tachycardia. The shivering caused rhabdomyolysis and necessitated cisatracurium infusion. The shivering failed to resolve after the patient was diagnosed and treated for ventilator-associated pneumonia. Suspecting sepsis as the etiology of shivering, the ECMO circuit temperature was increased to 38 °C, and the shivering was resolved. This case demonstrates therapeutic hyperthermia to treat infection-induced severe shivering and rhabdomyolysis while on ECMO.

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Section: Discussionmentioning

confidence: 99%

Severe Shivering on Venoarterial Extracorporeal Membrane Oxygenation—Raising the Circuit Temperature to Stop Rhabdomyolysis: A Case Report

et al. 2020

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“…On the other hand, after injuries, rhabdomyolysis, characterized by increased serum levels of myoglobin, creatine kinases (CK and CK-MB) and transaminases (ASAT and ALAT), often presents with acute renal injury. Evidence is accumulating that even therapeutic hypothermia may facilitate rhabdomyolysis in injured patients ( 123 , 124 ). To reduce the risks of rhabdomyolysis, experts recommend increased administration of isotonic fluids from the site of accident, and in case of myoglobinuria, sodium bicarbonate solution should be administered for urine alkalinization ( 123 ).…”

Section: Hypothermia-induced Changes In Organ Functionsmentioning

confidence: 99%

Physiological Changes in Subjects Exposed to Accidental Hypothermia: An Update

et al. 2022

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BackgroundAccidental hypothermia (AH) is an unintended decrease in body core temperature (BCT) to below 35°C. We present an update on physiological/pathophysiological changes associated with AH and rewarming from hypothermic cardiac arrest (HCA).Temperature Regulation and MetabolismTriggered by falling skin temperature, Thyrotropin-Releasing Hormone (TRH) from hypothalamus induces release of Thyroid-Stimulating Hormone (TSH) and Prolactin from pituitary gland anterior lobe that stimulate thyroid generation of triiodothyronine and thyroxine (T4). The latter act together with noradrenaline to induce heat production by binding to adrenergic β3-receptors in fat cells. Exposed to cold, noradrenaline prompts degradation of triglycerides from brown adipose tissue (BAT) into free fatty acids that uncouple metabolism to heat production, rather than generating adenosine triphosphate. If BAT is lacking, AH occurs more readily.Cardiac OutputAssuming a 7% drop in metabolism per °C, a BCT decrease of 10°C can reduce metabolism by 70% paralleled by a corresponding decline in CO. Consequently, it is possible to maintain adequate oxygen delivery provided correctly performed cardiopulmonary resuscitation (CPR), which might result in approximately 30% of CO generated at normal BCT.Liver and CoagulationAH promotes coagulation disturbances following trauma and acidosis by reducing coagulation and platelet functions. Mean prothrombin and partial thromboplastin times might increase by 40–60% in moderate hypothermia. Rewarming might release tissue factor from damaged tissues, that triggers disseminated intravascular coagulation. Hypothermia might inhibit platelet aggregation and coagulation.KidneysRenal blood flow decreases due to vasoconstriction of afferent arterioles, electrolyte and fluid disturbances and increasing blood viscosity. Severely deranged renal function occurs particularly in the presence of rhabdomyolysis induced by severe AH combined with trauma.ConclusionMetabolism drops 7% per °C fall in BCT, reducing CO correspondingly. Therefore, it is possible to maintain adequate oxygen delivery after 10°C drop in BCT provided correctly performed CPR. Hypothermia may facilitate rhabdomyolysis in traumatized patients. Victims suspected of HCA should be rewarmed before being pronounced dead. Rewarming avalanche victims of HCA with serum potassium > 12 mmol/L and a burial time >30 min with no air pocket, most probably be futile.

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“…Segundo Ciapetti et al (2011), A hipotermia ativa foi suspensa e passiva aquecimento iniciado. Os índices de rabdomiólise diminuíram imediatamente e, 06 horas depois, os valores de potássio e os índices de necrose foram normais.…”

Section: Relato De Casounclassified

Parada Cardíaca: Principais Complicações Ocasionadas Pela Síndrome Da Rabdomiólise

Araujo¹,

Silva²,

Silva³

et al. 2020

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A parada cardiorrespiratória (PCR) é uma situação clínica que acarreta prioridade de atendimento devido à necessidade de intervenções rápidas e eficazes. OBJETIVO: identificação da produção científica a nível internacional e nacional sobre as principais complicações fisiopatológicas advindas da síndrome rabdomiólise, MÉTODOS: trata-se de um estudo de revisão integrativa, realizada na bases de dados Biblioteca Virtual em Saúde (BVS), da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados em Enfermagem (BDENF), Scientific Eletronic Library Online (SciELO) e Medical Literature Analysisand Retrieval System Online (MEDLINE). RESULTADOS E DISCUSSÃO: O presente estudo possibilitou compreender e identificar a definição da condição patológica e sua ampla vertente e etiologia. Entretanto, além da sua relevância, identificou-se a limitação de conhecimento pelos profissionais da saúde, oriundo da escassez de estudo publicado na área. CONCLUSÃO: A falta de conhecimento pode causar algumas situações que interferem na atuação de toda a equipe na assistência prestada. É conferido ao enfermeiro a responsabilidade do suprimento do carrinho de parada e todos os materiais necessários, bem como os cuidados dispensados durante todo o evento. Palavras chave: Lesão muscular. Parada Cardíaca. Rabdomiólise.

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Rhabdomyolysis following therapeutic hypothermia after traumatic cardiac arrest

Cited by 8 publications

References 4 publications

Severe Shivering on Venoarterial Extracorporeal Membrane Oxygenation—Raising the Circuit Temperature to Stop Rhabdomyolysis: A Case Report

Severe Shivering on Venoarterial Extracorporeal Membrane Oxygenation—Raising the Circuit Temperature to Stop Rhabdomyolysis: A Case Report

Physiological Changes in Subjects Exposed to Accidental Hypothermia: An Update

Parada Cardíaca: Principais Complicações Ocasionadas Pela Síndrome Da Rabdomiólise

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