Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Abstract

Background and aim: Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).Methods: Relevant studies were identified after two consensus meetings of the SSAI Task Force on Therapeutic Hypothermia (SSAITFTH) and via literature search of the Cochrane Central Register of Controlled Trials and Medline. Evidence was assessed and consensus opinion was used when high‐grade evidence (Grade of Recommendation, GOR) was unavailable. A management strategy was developed as a consensus from the evidence and the protocols in the participating countries.Results and conclusion: Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic factors.

Serum Potassium Changes During Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest—Should It Be Treated?

“…Therapeutic hypothermia has been used for nearly 9 years as a standardized treatment after successful resuscitation from OHCA due to VF and non-shockable rhythms, but the treatment is associated with a number of adverse events (Castren et al, 2009;Kim et al, 2011;Lundbye et al, 2011). The correlation between potassium abnormalities and the tendency to suffer from arrhythmia is well established (Podrid, 1990;Cohn et al, 2000).…”

Effect of Gender on Outcome of Out of Hospital Cardiac Arrest in the Resuscitation Outcomes Consortium

“…Quality post arrest care includes the implementation of a comprehensive, multidisciplinary system of care with structured interventions. Of these only targeted temperature management has been shown to affect outcome; 58,59 however, it is conceivable that differences in-hospital care may lead to differences in long-term survival rates [60][61][62][63] after cardiac arrest, hence in future studies it is important to assess the impact of post arrest care on OHCA outcomes.…”

Neurocognitive dysfunction after cardiac surgery and biochemical markers

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