Therapeutic Hypothermia Following Emergent Coronary Artery Bypass Grafting After Failed Percutaneous Coronary Intervention in a Comatose Post-Cardiac Arrest Patient

Abstract

We report the case of 60-yr-old female in which therapeutic hypothermia (TH) was successfully induced maintaining the target temperature of 34℃ for 12 hr despite a risk of hypothermia-induced coagulation abnormalities following an emergent coronary artery bypass grafting (CABG) due to failed percutaneous coronary intervention, who suffered a cardiac arrest. Emergent CABG may be a relative contraindication for TH in post-cardiac arrest patients because hypothermia may increase the risk of infection and bleeding. However, the possibility of an improved neurologic outcome outweighs the risk of bleeding, although major surgery may be a relative contraindication for TH.

Optimal Protective Hypothermia in Arrested Mammalian Hearts

“…However, therapeutic hypothermia has been widely used. Since the 1990s, mild hypothermic protection has gotten a new look (Swinhar, 2005;Choi et al, 2013;Søreide et al, 2013;Bernard, 2014), as patients are protected to tolerate systemic hypoxic injury during incident rescue (Bernard, 2004) and to resist ischemic injury during surgery (Hollenbeck et al, 2012). The optimal temperature, method, onset, duration, rewarming rate, and therapeutic window remain unclear (Koreny et al, 2009;Erb et al, 2012;Leshnower et al, 2012;Miclescu et al, 2013).…”

“…The survival depends on multiplicands, including guideline quality, the levels of education, local implementation, and so on (Zobel et al, 2012). Recently, 32-34°C has been commonly used as the target hypothermia (Don et al, 2009;Kupchik, 2009;Gibson and Andrews, 2013); 32-33°C (Vollroth et al, 2013), 32.5°C (Murtha et al, 2014), 32.5-33.5°C (Bro-Jeppesen et al, 2012), 33°C (Zobel et al, 2012), 34°C (Choi et al, 2013;Testori et al, 2013), and 33-36°C (Nielsen et al, 2013) are also used. The results are different.…”