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Hypothermia cardiac arrest

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https://www.readbyqxmd.com/read/28433359/feasibility-of-profound-hypothermia-as-part-of-extracorporeal-life-support-in-a-pig-model
#1
Christoph Weiser, Wolfgang Weihs, Michael Holzer, Christoph Testori, Anne-Margarethe Kramer, Christoph Kment, Martin Stoiber, Michael Poppe, Christian Wallmüller, Peter Stratil, Michael Hoschitz, Anton Laggner, Fritz Sterz
OBJECTIVE: To investigate the feasibility of a refined aortic flush catheter and pump system to induce emergency preservation and resuscitation before extracorporeal cardiopulmonary resuscitation in a normovolemic cardiac arrest swine model simulating near real size/weight conditions of adults. METHODS: In this feasibility study, 8 female Large White breed pigs weighing 70 to 80 kg underwent ventricular fibrillation cardiac arrest for 15 minutes, followed by 4°C aortic flush (150 mL/kg for the brain; 50 mL/kg for the spine) via a new hardware ensued by resuscitation with extracorporeal cardiopulmonary resuscitation...
March 24, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28430068/caring-for-patients-or-organs-new-therapies-raise-new-dilemmas-in-the-emergency-department
#2
Arjun Prabhu, Lisa S Parker, Michael A DeVita
Two potentially lifesaving protocols, emergency preservation and resuscitation (EPR) and uncontrolled donation after circulatory determination of death (uDCDD), currently implemented in some U.S. emergency departments (EDs), have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to "buy time": one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation...
May 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28418788/factors-associated-with-delayed-cooling-in-cardiac-arrest-patients
#3
David A Pearson, Katherine Mayer, Catherine M Wares, Michael S Runyon, Jonathan R Studnek, Shana L Ward, Kathi M Kraft, Alan C Heffner
Therapeutic hypothermia has been shown to improve neurologic outcome in medical cardiac arrest patients, yet little is known about factors that delay target temperature achievement. Our primary aim was to identify factors associated with not achieving our institutional "door-to-cool" (DTC) performance goal (emergency department [ED] arrival to temperature of 34°C) of ≤4 hours. Secondary aims included whether achievement of DTC goal was associated with timing of bolus neuromuscular blockade (NMB), survival, or functional outcome...
April 18, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/28410771/the-esophageal-cooling-device-a-new-temperature-control-tool-in%C3%A2-the-intensivist-s-arsenal
#4
Ahmed F Hegazy, Danielle M Lapierre, Ron Butler, Janet Martin, Eyad Althenayan
BACKGROUND: Therapeutic hypothermia has been demonstrated to improve neurological outcome in comatose survivors of cardiac arrest. Current temperature control modalities however, have several limitations. Exploring innovative methods of temperature management has become a necessity. METHODS: We describe the first use of a novel esophageal cooling device as a sole modality for hypothermia induction, maintenance and rewarming in a series of four postcardiac arrest patients...
April 11, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28407722/induced-hypothermia-is-associated-with-reduced-circulating-subunits-of-mitochondrial-dna-in-cardiac-arrest-patients
#5
Hamid Aslami, Charlotte J P Beurskens, Anita M Tuip, Janneke Horn, Nicole P Juffermans
Induced hypothermia may protect from ischemia reperfusion injury. The mechanism of protection is not fully understood and may include an effect on mitochondria. Here we describe the effect of hypothermia on circulating mitochondrial (mt) DNA in a substudy of a multicenter randomized trial (the Target Temperature Management trial). Circulating levels of mtDNA were elevated in patients with cardiac arrest at all-time points compared to healthy controls. After 24 h of temperature management, patients kept at 33 °C had significantly lower levels of COX3, NADH1 and NADH2 compared to baseline, in contrast to those kept at 36 °C...
April 13, 2017: Mitochondrial DNA. Part A. DNA Mapping, Sequencing, and Analysis
https://www.readbyqxmd.com/read/28407232/observed-survival-benefit-of-therapeutic-hypothermia-re-analyzing-the-circ-trial
#6
Alexander Nürnberger, Harald Herkner, Fritz Sterz, Jan-Aage Olsen, Michael Lozano, Pierre M van Grunsven, Brooke E Lerner, David Persse, Reinhard Malzer, Marc A Brouwer, Mark Westfall, Chris M Souders, David T Travis, Ulrich R Herken, Lars Wik
BACKGROUND: Mild therapeutic hypothermia is argued being beneficial for outcome after cardiac arrest. MATERIALS AND METHODS: Retrospective analysis of Circulation Improving Resuscitation Care trial data to assess if therapeutic cooling to 33 ±1°C core temperature had an association with survival. Of 4,231 adult out-of-hospital cardiac arrests of presumed cardiac origin initially enrolled, eligibility criteria for therapeutic hypothermia were met by 1,812. Logistic regression was undertaken in a stepwise fashion to account for the impact on outcome of each significant difference and for the variable of interest between the groups...
April 13, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28405859/effects-of-mild-hypothermia-on-cerebral-large-and-small-microvessels-blood-flow-in-a-porcine-model-of-cardiac-arrest
#7
Junyuan Wu, Wei Yuan, Jiebin Li, Yongzhen Zhao, Jie Li, Zhenhua Li, Chunsheng Li
BACKGROUND: The effect of mild hypothermia (MH) on microcirculation after resuscitation from cardiac arrest is controversial. The aim of this study was to determine whether MH improves or aggravates the disturbance of cerebral microcirculation. METHODS: Twenty domestic male pigs were randomized into the MH group (n = 8), non-hypothermia (NH) group (n = 8) or sham operation group (n = 4). In the MH group, the animals were initiated rapid intravascular cooling at 1 h after return of spontaneous circulation (ROSC) from 8 min ventricular fibrillation, and the core temperature was reduced to 33 °C for 12 h and then rewarmed to 37 °C...
April 12, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28391258/dexmedetomidine-combined-with-therapeutic-hypothermia-is-associated-with-cardiovascular-instability-and-neurotoxicity-in-a-piglet-model-of-perinatal-asphyxia
#8
Mojgan Ezzati, Go Kawano, Eridan Rocha-Ferreira, Daniel Alonso-Alconada, Jane K Hassell, Kevin D Broad, Igor Fierens, Bobbi Fleiss, Alan Bainbridge, David L Price, Pardis Kaynezhad, Brian Anderson, Mariya Hristova, Ilias Tachtsidis, Xavier Golay, Pierre Gressens, Robert D Sanders, Nicola J Robertson
The selective α2-adrenoreceptor agonist dexmedetomidine has shown neuroprotective, analgesic, anti-inflammatory, and sympatholytic properties that may be beneficial in neonatal encephalopathy (NE). As therapeutic hypothermia is only partially effective, adjunct therapies are needed to optimize outcomes. The aim was to assess whether hypothermia + dexmedetomidine treatment augments neuroprotection compared to routine treatment (hypothermia + fentanyl sedation) in a piglet model of NE using magnetic resonance spectroscopy (MRS) biomarkers, which predict outcomes in babies with NE, and immunohistochemistry...
April 8, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28389857/predictors-of-good-neurologic-outcome-after-resuscitation-beyond-30%C3%A2-min-in-out-of-hospital-cardiac-arrest-patients-undergoing-therapeutic-hypothermia
#9
Shin Ahn, Byung Kook Lee, Chun Song Youn, Youn-Jung Kim, Chang Hwan Sohn, Dong-Woo Seo, Won Young Kim
Neurologically intact survival after cardiac arrest is possible even after prolonged resuscitation efforts. However, the factors associated with good neurologic outcome in these patients remain unknown. This study identifies predictors associated with good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). This multicenter, registry-based, retrospective cohort study conducted in 24 hospitals across South Korea between 2007 and 2012 includes adult (≥18 years) non-traumatic OHCA patients with prolonged (>30 min) downtime who underwent TTM treatment...
April 7, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28382198/adverse-drug-reactions-in-therapeutic-hypothermia-after-cardiac-arrest
#10
Robert Witcher, Amy L Dzierba, Catherine Kim, Pamela L Smithburger, Sandra L Kane-Gill
BACKGROUND: Therapeutic hypothermia (TH) improves survival and neurologic function in comatose survivors of cardiac arrest. Many medications used to support TH have altered pharmacokinetics and pharmacodynamics during this treatment. It is unknown if or at what frequency the medications used during TH cause adverse drug reactions (ADRs). METHODS: A retrospective chart review was conducted for patients admitted to an intensive care unit (ICU) after cardiac arrest and treated with TH from January 2009 to June 2012 at two urban, university-affiliated, tertiary-care medical centres...
March 2017: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/28355299/mild-hypothermia-alleviates-brain-oedema-and-blood-brain-barrier-disruption-by-attenuating-tight-junction-and-adherens-junction-breakdown-in-a-swine-model-of-cardiopulmonary-resuscitation
#11
Jiebin Li, Chunsheng Li, Wei Yuan, Junyuan Wu, Jie Li, Zhenhua Li, Yongzhen Zhao
Mild hypothermia improves survival and neurological recovery after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). However, the mechanism underlying this phenomenon is not fully elucidated. The aim of this study was to determine whether mild hypothermia alleviates early blood-brain barrier (BBB) disruption. We investigated the effects of mild hypothermia on neurologic outcome, survival rate, brain water content, BBB permeability and changes in tight junctions (TJs) and adherens junctions (AJs) after CA and CPR...
2017: PloS One
https://www.readbyqxmd.com/read/28352966/cold-blooded-evaluating-brain-temperature-by-mri-during-surface-cooling-of-human-subjects
#12
Eric J Curran, Daniel L Wolfson, Richard Watts, Kalev Freeman
BACKGROUND: Targeted temperature management (TTM) confers neurological and survival benefits for post-cardiac arrest patients with return of spontaneous circulation (ROSC) who remain comatose. Specialized equipment for induction of hypothermia is not available in the prehospital setting, and there are no reliable methods for emergency medical services personnel to initiate TTM. We hypothesized that the application of surface cooling elements to the neck will decrease brain temperature and act as initiators of TTM...
March 28, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28335785/we-need-to-include-bystander-first-aid-in-trauma-research
#13
Håkon Kvåle Bakke, Torben Wisborg
BACKGROUND: The chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystander first aid has resulted in improved outcome. Whereas, in trauma research the first link of the chain of survival is almost ignored. METHODS: In OHCA, cardiopulmonary resuscitation (CPR) from bystanders has been subject of a vast amount of research, as well as measures and programs to raise the rate of bystander CPR to cardiac arrest victims...
March 23, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28324998/prediction-of-the-outcome-in-cardiac-arrest-patients-undergoing-hypothermia-using-eeg-wavelet-entropy
#14
Hana Moshirvaziri, Nima Ramezan-Arab, Shadnaz Asgari
Cardiac arrest (CA) is the leading cause of death in the United States. Induction of hypothermia has been found to improve the functional recovery of CA patients after resuscitation. However, there is no clear guideline for the clinicians yet to determine the prognosis of the CA when patients are treated with hypothermia. The present work aimed at the development of a prognostic marker for the CA patients undergoing hypothermia. A quantitative measure of the complexity of Electroencephalogram (EEG) signals, called wavelet sub-band entropy, was employed to predict the patients' outcomes...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28315727/increasing-or-fluctuating-bispectral-index-values-during-post-resuscitation-targeted-temperature-management-can-predict-clinical-seizures-after-rewarming
#15
Kanae Ochiai, Atsushi Shiraishi, Yasuhiro Otomo, Yuuichi Koido, Takashi Kanemura, Masato Honma
AIM: To investigate whether an increasing bispectral index (BIS) value during targeted temperature management (TTM) correlates with increased clinical seizures after TTM or worse neurological prognoses after TTM. METHODS: We performed a retrospective prognostication study of patients who were treated with TTM after recovery of spontaneous circulation from cardiac arrest at a tertiary care hospital. We recorded the BIS regularly during TTM and calculated the correlations of the mean BIS values, standard deviations of the BIS values, and linear regression coefficient of the trend of the BIS values over time as index tests...
March 16, 2017: Resuscitation
https://www.readbyqxmd.com/read/28306631/thermoregulate-autoregulate-and-ventilate-brain-directed-critical-care-for-pediatric-cardiac-arrest
#16
Jonathan E Kurz, Craig M Smith, Mark S Wainwright
PURPOSE OF REVIEW: Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period. RECENT FINDINGS: The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28283549/mild-hypothermia-preserves-myocardial-conduction-during-ischemia-by-maintaining-gap-junction-intracellular-communication-and-sodium-channel-function
#17
Michelle Mj Nassal, Xiaoping Wan, Zack Dale, Isabelle Deschenes, Lance D Wilson, Joseph Stephen Piktel
BACKGROUND: Acute cardiac ischemia induces conduction velocity (CV) slowing and conduction block, promoting reentrant arrhythmias leading to sudden cardiac arrest (SCA). Previously, we found that mild hypothermia (MH, 32°C) attenuates ischemia-induced conduction block and CV slowing in a canine model of early global ischemia. Acute ischemia impairs cellular excitability and the GJ protein connexin 43 (Cx43). We hypothesized that MH prevented ischemia-induced conduction block and CV slowing by preserving GJ expression and localization...
March 10, 2017: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/28282398/association-of-serum-lactate-with-outcome-after-out-of-hospital-cardiac-arrest-treated-with-therapeutic-hypothermia
#18
Jean-Christophe Orban, Michaël Novain, Florian Cattet, Rémi Plattier, Mohamed Nefzaoui, Hervé Hyvernat, Olivier Raguin, Michel Kaidomar, Sébastien Kerever, Carole Ichai
AIMS: Lactate reflects hypoxic insult in many conditions and is considered as a prognosis factor. But, after cardiac arrest, its interest is still debated. Our study aimed to assess the prognosis value of lactate in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. METHODS: This retrospective observational study included out-of-hospital cardiac arrest patients treated with therapeutic hypothermia in four ICUs. Lactate levels were compared at different times during the first 24 hours according to outcome at ICU discharge and to the type of death (multiorgan or neurologic failure)...
2017: PloS One
https://www.readbyqxmd.com/read/28274812/pediatric-cardiac-arrest-due-to-drowning-and-other-respiratory-etiologies-neurobehavioral-outcomes-in-initially-comatose-children
#19
Beth S Slomine, Vinay M Nadkarni, James R Christensen, Faye S Silverstein, Russell Telford, Alexis Topjian, Joshua D Koch, Jill Sweney, Ericka L Fink, Mudit Mathur, Richard Holubkov, J Michael Dean, Frank W Moler
AIM: To describe the 1-year neurobehavioral outcome of survivors of cardiac arrest secondary to drowning, compared with other respiratory etiologies, in children enrolled in the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial. METHODS: Exploratory analysis of survivors (ages 1-18 years) who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation (ROC). Participants recruited from 27 pediatric intensive care units in North America received targeted temperature management [therapeutic hypothermia (33°C) or therapeutic normothermia (36...
March 6, 2017: Resuscitation
https://www.readbyqxmd.com/read/28271403/combination-treatment-with-methylene-blue-and-hypothermia-in-global-cerebral-ischemia
#20
Lei Li, Rongli Yang, Pingjing Li, Hailong Lu, Jingbo Hao, Liyan Li, Donovan Tucker, Quanguang Zhang
Therapeutic hypothermia (TH) is the most potent therapeutic strategy for global cerebral ischemia (GCI), usually induced by cardiac arrest. TH has been shown both to suppress the delayed neuronal cell death in the vulnerable hippocampal CA1 subregion and to improve neurological outcomes in experimental animals after GCI. However, given the multiple adverse effects resulting from TH, application of such a therapy is typically limited. In recent years, methylene blue (MB) has emerged as a potential therapeutic drug for the treatment of neurodegenerative diseases...
March 7, 2017: Molecular Neurobiology
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