#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Therapeutical hypothermia after cardiac arrest


Authors: Škulec Roman
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové
Published in: Anest. intenziv. Med., 23, 2012, č. 3, s. 138-146
Category: Update in Intensive Care Medicine

Overview

This review article of therapeutic hypothermia (TH) in cardiac arrest survivors is a transcription of the lecture presented at the Update In Intensive Care Medicine 2011 course by the Institute for Postgraduate Medical Education. In the light of current knowledge, the author describes the place of TH in complex post-cardiac arrest intensive care, analyzes answers to the questions „When to start cool?“, „Whom to cool?“, „For how long and how deep to cool?“ and „How to cool?“, assesses practical issues of delivering TH and presents a personal opinion on the current discussion whether TH should be used or not. TH in cardiac arrest patiens is an effective method to prevent posthypoxic encephalopathy. Cooling should be initiated as soon as possible. The target body temperature of 33 °C should be reached as fast as possible with further maintainance in the range of 32–34 °C for 12–24 hours. Rewarming should be controled to avoid rewarming rates higher than 0.5 °C/h. The procedure should be guided by a written protocol and performed in the setting of complex intensive care.

Keywords:
cardiac arrest – therapeutic hypothermia


Sources

1. Nunnally, M. E. et al. Targeted temperature management in critical care: a report and recommendations from five professional societies. Crit. Care Med., 2011, 39, p. 1113–1125.

2. Nolan, J. P. et al. Advancement Life support Task Force of the International Liaison committee on Resuscitation: Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation, 2003, 57, p. 231–235.

3. Nolan, J. P. et al., European Resuscitation Council: European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation, 2005, 67 Suppl 1, p. S39–S86.

4. Cvachovec, K. et al. Konsenzuální stanovisko k použití terapeutické hypotermie. Anest. intenziv. Med., 2009, 20, p. 221–224.

5. Cvachovec, K. et al. Konsenzuální stanovisko k použití terapeutické hypotermie. Urg. Med., 2009, roč. 12, s. 31–33.

6. Šeblová, J. et al. Doporučení pro používání terapeutické mírné hypotermie v přednemocniční neodkladné péči u nemocných po mimonemocniční náhlé zástavě oběhu: doporučený postup č. 17. Urg. Med., 2010, roč. 13, s. 22–25.

7. Deakin, C. D. et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation, 2010, 81, p. 1305–1352.

8. Nolan, J. P. et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation, 2008, 79, p. 350–379.

9. Škulec, R. et al. Current cooling methods for induction of mild hypothermia in cardiac arrest survivors. Vnitr. Lek., 2009, roč. 55, s. 1060–1069.

10. Erecinska, M. et al. Effects of hypothermia on energy metabolism in mammalian central nervous system. J. Cereb. Blood Flow Metab., 2003, 23, p. 513–530.

11. Ošťádal, P. Ischemia-reperfusion injury following cardiac arrest and protective effects of hypothermia. Kardiol. Rev., 2009, roč. 11, s. 11–15.

12. Polderman, K. H. Mechanisms of action, physiological effects, and complications of hypothermia. Crit. Care Med., 2009, 37 (7 Suppl), p. S186–S202.

13. Liu, L. et al. Therapeutic hypothermia: neuroprotective mechanisms. Front. Biosci., 2007, 12, p. 816–825.

14. Busto, R. et al. Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke, 1989, 20, p. 904–910.

15. Kataoka, K. et al. Mild hypothermia – a revived countermeasure against ischemic neuronal damages. Neurosci. Res., 1998, 32, p. 103–117.

16. Globus, M. Y. et al. Detection of free radical activity during transient global ischemia and recirculation: effects of intraischemic brain temperature modulation. J. Neurochem., 1995, 65, p. 1250–1256.

17. Lei, B. et al. Effect of moderate hypothermia on lipid peroxidation in canine brain tissue after cardiac arrest and resuscitation. Stroke, 1994, 25, p. 147–152.

18. Xu, L. et al. Mild hypothermia reduces apoptosis of mouse neurons in vitro early in the cascade. J. Cereb. Blood Flow Metab., 2002, 22, p. 21–28.

19. Huang, Z. G. et al. Biphasic opening of the blood-brain barrier following transient focal ischemia: effects of hypothermia. Can. J. Neurol. Sci., 1999, 26, p. 298–304.

20. Fischer, S. et al. Hypothermia abolishes hypoxia-induced hyperpermeability in brain microvessel endothelial cells. Brain Res. Mol., 1999, 74, p. 135–144.

21. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N. Engl. J. Med., 2002, 346, p. 549–556.

22. Bernard, S. A. et al. Treatment of comatose survivors of out--of-hospital cardiac arrest with induced hypothermia. N. Engl. J. Med., 2002, 346, p. 557–563.

23. Arrich, J. European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group. Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit. Care Med., 2007, 35, p. 1041–1047.

24. Oksanen, T. et al. Intensium Consortium study group. Therapeutic hypothermia after cardiac arrest: implementation and outcome in Finnish intensive care units. Acta Anaesthesiol. Scand., 2007, 51, p. 866–871.

25. Holzer, M. et al. Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach. Stroke, 2006, 37, p. 1792–1797.

26. Nielsen, N. et al. Hypothermia after cardiac arrest should be further evaluated-A systematic review of randomised trials with meta-analysis and trial sequential analysis. Int. J. Cardiol., 2011, 151, p. 333–341.

27. Sunde, K. et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation, 2007, 73, p. 29–39.

28. Werling, M. et al. Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced. Resuscitation, 2007, 73, p. 40–45.

29. Tømte, O. et al. Strong and weak aspects of an established post-resuscitation treatment protocol-A five-year observational study. Resuscitation, 2011, 82, p. 1186–1193.

30. Škulec, R. et al. Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome. Acta Anaesthesiol. Scand., 2008, 52, p. 188–194.

31. Virkkunen, I. et al. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer’s solution: a pilot study. Resuscitation, 2004, 62, p. 299–302.

32. Kämäräinen, A. et al. Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: a randomized controlled trial. Acta Anaesthesiol. Scand., 2009, 53, p. 900–907.

33. Hammer, L. et al. Immediate prehospital hypothermia protokol in comatose survivors of out-of-hospital cardiac arrest. Am. J. Emerg. Med., 2009, 27, p. 570–573.

34. Kim, F. et al. Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation, 2007, 115, p. 3064–3070.

35. Castrén, M. et al. Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation, 2010, 122, p. 729–736.

36. Skulec, R. et al. Pre-hospital cooling of patients following cardiac arrest is effective using even low volumes of cold saline. Crit. Care, 2010, 14, R231.

37. Haugk, M. et al.; Time to Target Temperature Study Group. Relationship between time to target temperature and outcome in patients treated with therapeutic hypothermia after cardiac arrest. Crit. Care, 2011, 15, R101.

38. Nielsen, N. et al.; Hypothermia Network. Outcome, timing and adverse events in therapeutic hypothermia after out-of--hospital cardiac arrest. Acta Anaesthesiol. Scand., 2009, 53, p. 926–934.

39. Škulec, R. et al. The practice of therapeutic mild hypothermia in cardiac arrest survivors in the Czech Republic. Minerva Anestesiol., 2010, 76, p. 617–623.

40. Merchant, R. M. et al. Therapeutic hypothermia after cardiac arrest: unintentional overcooling is common using ice packs and conventional cooling blankets. Crit. Care Med., 2006, 34 (12 Suppl), p. S490–S494.

41. Škulec, R. et al. Overcooling during mild hypothermia in cardiac arrest survivors-phenomenon we should keep in mind. Vnitr. Lek., 2008, 54, p. 609–614.

42. Losert, H. et al. Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12h after cardiac arrest might not be necessary. Resuscitation, 2008, 76, p. 214–220.

43. Polderman, K. H. Mechanisms of action, physiological effects, and complications of hypothermia. Crit. Care Med., 2009, 37, 7 Suppl., p. S186–S202.

44. Koester, R. et al. Coronary angiography and intervention during hypothermia can be performed safely without cardiac arrhythmia or vasospasm. Clin. Res. Cardiol., 2011, 100, p. 1013–1019.

45. Noc, M. Hypothermia during percutaneous coronary intervention in comatose survivors of cardiac arrest. Signa vitae, 2010, 5, Suppl. 1, p. 13–16.

46. Schefold, J. C. et al. Mild therapeutic hypothermia after cardiac arrest and the risk of bleeding in patients with acute myocardial infarction. Int. J. Cardiol., 2009, 132, p. 387–391.

47. Murphy, M. C. et al. Hypothermia Does Not Ameliorate Post--Cardiac Arrest Myocardial Dysfunction. Circulation, 2010, 122, Suppl., p. A235.

48. Walters, J. H. et al. The role of hypothermia in post-cardiac arrest patients with return of spontaneous circulation: a systematic review. Resuscitation, 2011, 82, p. 508–516.

Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#