State‐of‐the‐art paper: Therapeutic hypothermia in out of hospital cardiac arrest survivors

Alkadri, Mohi E.; Peters, Matthew; Katz, Morgan J.; White, Christopher J.

doi:10.1002/ccd.24914

Cited by 9 publications

(3 citation statements)

References 98 publications

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“…Due to the lack of a direct comparison of clinical outcome data, it is not known whether another TH method is significantly better. In the past, it was thought that faster cooling and greater stability of the target temperature may improve the survival rate and the integrity of nervous system function, but further clinical research evidence is needed [20]. Which method is better?…”

Section: Introductionmentioning

confidence: 99%

Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

Liao

Zhou

et al. 2020

Crit Care

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Objectives: This study conducted a meta-analysis to assess the effectiveness, stability, and safety of mild therapeutic hypothermia (TH) induced by endovascular cooling (EC) and surface cooling (SC) and its effect on ICU, survival rate, and neurological function integrity in adult CA patients. Methods: We developed inclusion criteria, intervention protocols, results, and data collection. The results included outcomes during target temperature management as well as ICU stay, survival rate, and neurological functional integrity. The characteristics of the included population and each study were analyzed. Results: Four thousand nine hundred thirteen participants met the inclusion criteria. Those receiving EC had a better cooling efficiency (cooling rates MD = 0.31[0.13, 0.50], p < 0.01; induced cooling times MD = − 90.45[− 167.57, − 13.33], p = 0.02; patients achieving the target temperature RR = 1.60[1.19, 2.15], p < 0.01) and thermal stability during the maintenance phase (maintenance time MD = 2.35[1.22, 3.48], p < 0.01; temperature fluctuation MD = − 0.68[− 1.03, − 0.33], p < 0.01; overcooling RR = 0.33[0.23, 0.49], p < 0.01). There were no differences in ICU survival rate (RR = 1.22[0.98, 1.52], p = 0.07, I 2 = 0%) and hospital survival rate (RR = 1.02 [0.96, 1.09], p = 0.46, I 2 = 0%), but EC reduced the length of stay in ICU (MD = − 1.83[− 3.45, − 0.21], p = 0.03, I 2 = 49%) and improved outcome of favorable neurological function at discharge (RR = 1.15[1.04, 1.28], p < 0.01, I 2 = 0%). EC may delay the hypothermia initiation time, and there was no significant difference between the two cooling methods in the time from the start of patients' cardiac arrest to achieve the target temperature (MD = − 46.64[− 175.86, 82.58]). EC was superior to non-ArcticSun in terms of cooling efficiency. Although there was no statistical difference in ICU survival rate, ICU length of stay, and hospitalization survival rate, in comparison to non-ArcticSun, EC improved rates of neurologically intact survival (RR = 1.16 [1.01, 1.35], p = 0.04, I 2 = 0%).

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Section: Introductionmentioning

confidence: 99%

Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

Liao

Zhou

et al. 2020

Crit Care

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“…Hypothermia has a relevant impact on physiological regulatory mechanisms in the pulmonary, neurologic, hemostatic and cardiovascular system [ 1 ]. In a clinical setting, targeted temperature management (TTM) previously known as therapeutic hypothermia has become an important method of treatment to improve the neurological outcome, yielding a significant increase in long-term survival after cardiac arrest [ 2 – 4 ]. Deflecting the attention on the heart, hypothermia-induced electrophysiological changes can be observed through morphologic variances in the electrocardiogram (ECG) recording [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Modeling hypothermia induced effects for the heterogeneous ventricular tissue from cellular level to the impact on the ECG

et al. 2017

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Hypothermia has a profound impact on the electrophysiological mechanisms of the heart. Experimental investigations provide a better understanding of electrophysiological alterations associated with cooling. However, there is a lack of computer models suitable for simulating the effects of hypothermia in cardio-electrophysiology. In this work, we propose a model that describes the cooling-induced electrophysiological alterations in ventricular tissue in a temperature range from 27°C to 37°C. To model the electrophysiological conditions in a 3D left ventricular tissue block it was essential to consider the following anatomical and physiological parameters in the model: the different cell types (endocardial, M, epicardial), the heterogeneous conductivities in longitudinal, transversal and transmural direction depending on the prevailing temperature, the distinct fiber orientations and the transmural repolarization sequences. Cooling-induced alterations on the morphology of the action potential (AP) of single myocardial cells thereby are described by an extension of the selected Bueno-Orovio model for human ventricular tissue using Q10 temperature coefficients. To evaluate alterations on tissue level, the corresponding pseudo electrocardiogram (pECG) was calculated. Simulations show that cooling-induced AP and pECG-related parameters, i.e. AP duration, morphology of the notch of epicardial AP, maximum AP upstroke velocity, AP rise time, QT interval, QRS duration and J wave formation are in good accordance with literature and our experimental data. The proposed model enables us to further enhance our knowledge of cooling-induced electrophysiological alterations from cellular to tissue level in the heart and may help to better understand electrophysiological mechanisms, e.g. in arrhythmias, during hypothermia.

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“…It commonly causes a relative bradycardia and increased systemic vascular resistance. The incidence of serious complications with mild hypothermia is infrequent, with the vast majority of evidence showing a clear benefit from this therapy [10].…”

Section: Therapeutic Hypothermiamentioning

confidence: 99%

Out-of-hospital cardiac arrest

Kanakadandi

Kern²

2015

Coronary Artery Disease

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Targeted temperature management and early coronary angiography have become the standard of care for postcardiac arrest patients remaining comatose and with ST-segment elevation on the ECG. Less clear is the optimal approach for similar patients without ST-segment elevation on the postresuscitation ECG. However, current data from nonrandomized cohort studies suggest that many of these patients also benefit from an aggressive approach to postresuscitation care. Recent reports of increased stent thrombosis in the postarrest population need further exploration.

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State‐of‐the‐art paper: Therapeutic hypothermia in out of hospital cardiac arrest survivors

Cited by 9 publications

References 98 publications

Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

Modeling hypothermia induced effects for the heterogeneous ventricular tissue from cellular level to the impact on the ECG

Out-of-hospital cardiac arrest

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