Therapeutic hypothermia after cardiac arrest

Hölzer, Michael; Behringer, Wilhelm

doi:10.1097/01.aco.0000162835.33474.a9

Cited by 21 publications

(12 citation statements)

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“…Firstly, a failure of perfusion caused by global hypoperfusion, with or without coronary artery stenosis or occlusion, leads to ischaemia of the myocardium and resultant ischaemic damage [1,[19][20][21]. Secondly, reperfusion of the ischaemic tissue, occurring when an adequate perfusion pressure is restored or when coronary revascularisation occurs, leads to reperfusion and re-oxygenation injury [25].…”

Section: Resultsmentioning

confidence: 99%

“…These harmful effects are reversible with rewarming. Most patients who have a cardiac arrest do not survive, and full neurological recovery occurs in only 6-23% [1]. In order to improve survival and reduce such neurological injury, guidelines have recently been published describing the post-cardiac arrest bundle of care: this includes early coronary reperfusion if appropriate (primary angioplasty or thrombolysis), haemodynamic optimisation, and control of ventilation, blood glucose, temperature and seizures [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…In an animal model of AMI, Ning et al [21] showed that hypothermia suppressed anaerobic metabolism, reduced myocardial oxygen consumption and decreased myocardial energy utilisation during ischaemia. Secondly, hypothermia counteracts the problems associated with reperfusion and re-oxygenation: hypothermia protects lipid membrane fluidity, inhibits lipid peroxidation, slows destructive enzymatic processes, reduces cytochrome C release [1,28,29] and has an effect on protein kinase C [25,30], nitric oxide generation [25] and calcium homeostasis [30]. Ning et al reported that hypothermia resulted in preservation of collagen integrity, an increase in survival proteins, inhibition of apoptotic pathways and promotion of signalling for cell survival [21].…”

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confidence: 99%

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The effects of mild induced hypothermia on the myocardium: a systematic review

Kelly

Nolan

2010

Anaesthesia

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SummaryMild induced hypothermia improves neurological outcome and reduces mortality among initially comatose survivors of out-of-hospital cardiac arrest. Similar pathological processes occur in the heart and the brain, namely ischaemia followed by reperfusion injury. Animal data indicate that mild induced hypothermia results in improved myocardial salvage, reduced infarct size, reduced left ventricular remodelling and better long-term left ventricular function. Several small human studies suggest that infarct size may be reduced by mild induced hypothermia, although this has not reached significance in any human study to date. There are variable reports of harm to the myocardium caused by mild induced hypothermia, including reduced myocardial contractility and cardiac output, electrocardiographic changes and arrhythmias, especially bradycardia. These harmful effects are reversible with rewarming. Most patients who have a cardiac arrest do not survive, and full neurological recovery occurs in only 6-23% [1]. In order to improve survival and reduce such neurological injury, guidelines have recently been published describing the post-cardiac arrest bundle of care: this includes early coronary reperfusion if appropriate (primary angioplasty or thrombolysis), haemodynamic optimisation, and control of ventilation, blood glucose, temperature and seizures [2,3].Therapeutic hypothermia has become established as a recognised intervention following cardiac arrest [2]. Two randomised controlled trials have shown improved neurological outcome and reduced mortality in adults who were therapeutically cooled following out-ofhospital ventricular fibrillation (VF) cardiac arrest, where the patient was comatose following initial resuscitation, and where cooling was initiated within minutes to hours [4,5]. The International Liaison Committee on Resuscitation has recommended that all unconscious adult patients with spontaneous circulation after out-of-hospital VF cardiac arrest should be cooled to 32-34°C for 12-24 h [6]. Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest [6].Cardiac arrest is thought to cause neurological injury by several mechanisms, including perfusion failure leading to cerebral ischaemia, and reperfusion leading to re-oxygenation injury [7][8][9][10]. Therapeutic hypothermia is thought to attenuate both these processes. Firstly, hypothermia is thought to protect against many of the processes associated with reperfusion and re-oxygenation [14][15][16][17][18]. Secondly, hypothermia reduces the cerebral metabolic rate for oxygen (CMRO 2 ) [11], and may therefore provide protection from ongoing cerebral ischaemia [12,13].Similar pathological processes occur in the heart following cardiac arrest and ⁄ or acute myocardial infarction (AMI), including perfusion failure followed by reperfusion and re-oxygenation injury [19][20][21][22]. It has been suggested that mild induced hypothermia may also be beneficial to the myocardium in a similar way that it is neuroprotective to the brain [2...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effects of mild induced hypothermia on the myocardium: a systematic review

Kelly

Nolan

2010

Anaesthesia

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“…In the European study, the median Glasgow Coma Scale score on hospital admission in both groups was 3 with an interquartile range of 3 to 5 in the group with normothermia and 3 to 4 in the group with hypothermia. 20 Ten patients in the European study were resuscitated after in-hospital cardiac arrest (M. Holzer, written communication, October 2002). Additional criteria for entry into the European study were witnessed cardiac arrest, an estimated interval of 5 to 15 minutes from patient collapse to first resuscitation attempt by emergency medical services personnel, and an interval of Յ60 minutes from collapse to ROSC.…”

Section: Clinical Studiesmentioning

confidence: 99%

Therapeutic Hypothermia After Cardiac Arrest

Nolan¹,

Morley²,

Hoek³

et al. 2003

Circulation

792

194

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“…Most patients who suffer a cardiac arrest (CA) do not survive, and full neurological recovery occurs in only 6 to 23% [1]. Mild therapeutic hypothermia (MTH) is nowadays an established treatment to limit neurological injury and to improve outcome in CA patients after successful resuscitation [2,3].…”

Section: Introductionmentioning

confidence: 99%

Automated peritoneal lavage: an extremely rapid and safe way to induce hypothermia in post-resuscitation patients

et al. 2013

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IntroductionMild therapeutic hypothermia (MTH) is a worldwide used therapy to improve neurological outcome in patients successfully resuscitated after cardiac arrest (CA). Preclinical data suggest that timing and speed of induction are related to reduction of secondary brain damage and improved outcome.MethodsAiming at a rapid induction and stable maintenance phase, MTH induced via continuous peritoneal lavage (PL) using the Velomedix® Inc. automated PL system was evaluated and compared to historical controls in which hypothermia was achieved using cooled saline intravenous infusions and cooled blankets.ResultsIn 16 PL patients, time to reach the core target temperature of 32.5°C was 30 minutes (interquartile range (IQR): 19 to 60), which was significantly faster compare to 150 minutes (IQR: 112 to 240) in controls. The median rate of cooling during the induction phase in the PL group of 4.1°C/h (IQR: 2.2 to 8.2) was significantly faster compared to 0.9°C/h (IQR: 0.5 to 1.3) in controls. During the 24-hour maintenance phase mean core temperature in the PL patients was 32.38 ± 0.18°C (range: 32.03 to 32.69°C) and in control patients 32.46 ± 0.48°C (range: 31.20 to 33.63°C), indicating more steady temperature control in the PL group compared to controls. Furthermore, the coefficient of variation (VC) for temperature during the maintenance phase was lower in the PL group (VC: 0.5%) compared to the control group (VC: 1.5%). In contrast to 23% of the control patients, none of the PL patients showed an overshoot of hypothermia below 31°C during the maintenance phase. Survival and neurological outcome was not different between the two groups. Neither shivering nor complications related to insertion or use of the PL method were observed.ConclusionsUsing PL in post-CA patients results in a rapidly reached target temperature and a very precise maintenance, unprecedented in clinical studies evaluating MTH techniques. This opens the way to investigate the effects on neurological outcome and survival of ultra-rapid cooling compared to standard cooling in controlled trials in various patient groups.Trial RegistrationClinicalTrials.gov: NCT01016236See related letter by Esnault et al., http://ccforum.com/content/17/3/431

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Therapeutic hypothermia after cardiac arrest

Cited by 21 publications

References 63 publications

The effects of mild induced hypothermia on the myocardium: a systematic review

The effects of mild induced hypothermia on the myocardium: a systematic review

Therapeutic Hypothermia After Cardiac Arrest

Automated peritoneal lavage: an extremely rapid and safe way to induce hypothermia in post-resuscitation patients

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