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Targetted temperature management

Brian L Chang, Mary P Mercer, Nichole Bosson, Karl A Sporer
Introduction: The development of cardiac arrest centers and regionalization of systems of care may improve survival of patients with out-of-hospital cardiac arrest (OHCA). This survey of the local EMS agencies (LEMSA) in California was intended to determine current practices regarding the treatment and routing of OHCA patients and the extent to which EMS systems have regionalized OHCA care across California. Methods: We surveyed all of the 33 LEMSA in California regarding the treatment and routing of OHCA patients according to the current recommendations for OHCA management...
March 2018: Western Journal of Emergency Medicine
Marine Paul, Wulfran Bougouin, Florence Dumas, Guillaume Geri, Benoit Champigneulle, Lucie Guillemet, Omar Ben Hadj Salem, Stéphane Legriel, Jean-Daniel Chiche, Julien Charpentier, Jean-Paul Mira, Claudio Sandroni, Alain Cariou
PURPOSE: Although guidelines on post-resuscitation care recommend the use of short-acting agents for sedation during targeted temperature management (TTM) after cardiac arrest (CA), the potential advantages of this strategy have not been clinically demonstrated. METHODS: We compared two sedation regimens (propofol-remifentanil, period P2, vs midazolam-fentanyl, period P1) among comatose TTM-treated CA survivors. Management protocol, apart from sedation and neuromuscular blockers use, did not change between the two periods...
March 16, 2018: Resuscitation
Idrees Salam, Jakob Hartvig Thomsen, Jesper Kjaergaard, John Bro-Jeppesen, Martin Frydland, Matilde Winther-Jensen, Lars Køber, Michael Wanscher, Christian Hassager, Helle Søholm
OBJECTIVE: Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM). DESIGN: Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002-2011 were included. Utstein-based pre- and in-hospital data collection was performed...
March 19, 2018: Scandinavian Cardiovascular Journal: SCJ
Henrik Staer-Jensen, Kjetil Sunde, Espen Rostrup Nakstad, Jan Eritsland, Geir Øystein Andersen
OBJECTIVES: Haemodynamic monitoring during post arrest care is important to optimise treatment. We compared stroke volume measured by minimally-invasive monitoring devices with or without thermodilution calibration, and transthoracic echocardiography (TTE), and hypothesised that thermodilution calibration would give stroke volume index (SVI) more in agreement with TTE during targeted temperature management (TTM). DESIGN: Comatose out-of-hospital cardiac arrest survivors receiving TTM (33 °C for 24 hrs) underwent haemodynamic monitoring with arterial pulse contour analyses with (PiCCO2®) and without (FloTrac® /Vigileo® monitor® ) transpulmonary thermodilution calibration...
March 16, 2018: Scandinavian Cardiovascular Journal: SCJ
Jinzhao Song, Vikram Pandian, Michael G Mauk, Haim H Bau, Sara Cherry, Laurence C Tisi, Changchun Liu
Rapid and quantitative molecular diagnostics in the field, at home, and at remote clinics is essential for evidence-based disease management, control, and prevention. Conventional molecular diagnostics requires extensive sample preparation, complex instruments, and skilled personnel, restricting its use to centralized laboratories. To overcome these limitations, we designed a simple, inexpensive, hand-held, smartphone-based mobile detection platform, dubbed "smart-connected cup" (SCC), for rapid, connected and quantitative molecular diagnostics...
March 15, 2018: Analytical Chemistry
Christian Hassager, Ken Nagao, David Hildick-Smith
The prognosis after out-of-hospital cardiac arrest (OHCA) has improved in the past few decades because of advances in interventions used outside and in hospital. About half of patients who have OHCA with initial ventricular tachycardia or ventricular fibrillation and who are admitted to hospital in coma after return of spontaneous circulation will survive to discharge with a reasonable neurological status. In this Series paper we discuss in-hospital management of patients with post-cardiac-arrest syndrome. In most patients, the most important in-hospital interventions other than routine intensive care are continuous active treatment (in non-comatose and comatose patients and including circulatory support in selected patients), cooling of core temperature to 32-36°C by targeted temperature management for at least 24 h, immediate coronary angiography with or without percutaneous coronary intervention, and delay of final prognosis until at least 72 h after OHCA...
March 10, 2018: Lancet
Patrick J Lindsay, Danielle Buell, Damon C Scales
BACKGROUND: Mild therapeutic hypothermia (TH), or targeted temperature management, improves survival and neurological outcomes in patients after out-of-hospital cardiac arrest (OHCA). International guidelines strongly support initiating TH for all eligible individuals presenting with OHCA; however, the timing of cooling initiation remains uncertain. This systematic review and meta-analysis was conducted with all available randomised controlled trials (RCTs) included to explore the efficacy and safety of initiating pre-hospital TH in patients with OHCA...
March 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Yong Soo Cho, Byung Kook Lee, Dong Hun Lee, Yong Hun Jung, Sung Min Lee, Jung Soo Park, Kyung Woon Jeung
PURPOSE: The optimal timing for measurement of neutrophil gelatinase-associated lipocalin (NGAL) level to predict acute kidney injury (AKI) and prognosis in cardiac arrest (CA) survivors has not been elucidated. We aimed to compare the diagnostic and prognostic performance of NGAL levels after return of spontaneous circulation (ROSC) and at 48 h after CA. METHODS: We included 231 adult cardiac arrest survivors who underwent targeted temperature management between May 2013 and December 2016...
March 13, 2018: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
Isabelle Beuchat, Daria Solari, Jan Novy, Mauro Oddo, Andrea O Rossetti
INTRODUCTION: Standardized EEG patterns according to the American Clinical Neurophysiology Society (ACNS) ("highly malignant", "malignant" and "benign") demonstrated good correlation with outcome after cardiac arrest (CA). However, this approach relates to EEGs after target temperature management (TTM), and correlation to other recognized outcome predictors remains unknown. OBJECTIVES: To investigate the relationship between categorized EEG and other outcome predictors, during and after TTM, at different temperatures...
March 9, 2018: Resuscitation
Lisa Letzkus, Nancy Addison, Lauren Turner, Mark Conaway, Beth Quatrara
PROBLEM: Paroxysmal sympathetic hyperactivity (PSH) is a complicated phenomenon that presents as autonomic instability and muscle overactivity in individuals who experience severe brain injury. Identifying potential modifiable environmental nociceptive stimuli is necessary for developing interventions that impact clinical outcomes. OBJECTIVE: The aim of this study was to identify physical environmental nociceptive stimuli that could hinder recovery for children who experience PSH after severe brain injury...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Fred Rincon
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management...
April 2018: Neurosurgery Clinics of North America
Ward Eertmans, Cornelia Genbrugge, Margot Vander Laenen, Willem Boer, Dieter Mesotten, Jo Dens, Frank Jans, Cathy De Deyne
BACKGROUND: We investigated the ability of bispectral index (BIS) monitoring to predict poor neurological outcome in out-of-hospital cardiac arrest (OHCA) patients fully treated according to guidelines. RESULTS: In this prospective, observational study, 77 successfully resuscitated OHCA patients were enrolled in whom BIS, suppression ratio (SR) and electromyographic (EMG) values were continuously monitored during the first 36 h after the initiation of targeted temperature management at 33 °C...
March 2, 2018: Annals of Intensive Care
Sung Wook Kim, Joo Suk Oh, Jungtaek Park, Hyun Ho Jeong, Ji Hoon Kim, Jung Hee Wee, Sang Hoon Oh, Seung Pill Choi, Kyu Nam Park
OBJECTIVES: The absence of N20 somatosensory evoked potential after cardiac arrest is related to poor outcome. However, discrimination between the low-amplitude and the absence of N20 is challenging. P25 and P30 are short-latency positive peaks with latencies between 25 and 30 ms following N20 (P25/30). P25/30 is evident even with an ambiguous N20 in patients with good outcome. Therefore, we evaluated the predictive value of P25/30 after cardiac arrest. DESIGN: A retrospective observational study...
March 1, 2018: Critical Care Medicine
Kerstin K Zander, Supriya Mathew, Stephen T Garnett
Australia experiences frequent heat waves and generally high average temperatures throughout the continent with substantial impacts on human health and the economy. People adapt to heat by adopting various relief measures in their daily lives including changing their behaviour. Many labour intensive outdoor industries implement standards for heat stress management for their workforce. However, little is known about how people cope with heat at their workplaces apart from studies targeting some specific industries where labourers are exposed to extreme heat...
February 26, 2018: International Journal of Environmental Research and Public Health
Micaela Carwell
Therapeutic hypothermia, also referred to as targeted temperature management, has been a component of the postcardiac arrest treatment guidelines since 2010. Although almost a decade has passed since its inclusion in the postarrest guidelines, many unanswered questions remain regarding selection of the appropriate patient population, optimal target temperature, ideal window of time in which to initiate therapy after arrest, most efficient, safe, and accurate equipment choice for inducing and maintaining hypothermia, most effective duration of treatment, and rate of cooling or rewarming...
April 2018: Critical Care Nursing Quarterly
Joseph H Pitcher, John Dziodzio, Joshua Keller, Teresa May, Richard R Riker, David B Seder
BACKGROUND: Hypotension, hyperglycemia, dysoxia, and dyscarbia may contribute to reperfusion injury, and each is independently associated with poor outcome (PO) after cardiac arrest. We investigated whether the combined effects of these physiological derangements are associated with cardiac arrest outcomes. METHODS: This institutional review board-approved retrospective cohort study included consecutive resuscitated cardiac arrest patients that received targeted temperature management at Maine Medical Center from 2013 to 2015...
February 28, 2018: Neurocritical Care
Bernard W Laughlin, Isaac R Bailey, Sarah A Rice, Zeinab Barati, Lori K Bogren, Kelly L Drew
Targeted temperature management is standard of care for cardiac arrest and is in clinical trials for stroke. N6 -cyclohexyladenosine (CHA), an A1 adenosine receptor agonist, inhibits thermogenesis and induces onset of hibernation in hibernating species. Despite promising thermolytic efficacy of CHA, prior work has failed to achieve and maintain a prescribed target core body temperature (Tb ) between 32°C and 34°C for 24 hours. We instrumented Sprague-Dawley rats (n = 19) with indwelling arterial and venous cannulae and a transmitter for monitoring Tb and ECG, then administered CHA via continuous IV infusion or intraperitoneal (IP) injection...
February 26, 2018: Therapeutic Hypothermia and Temperature Management
Weiwei Yao, Yuansheng Chen
Colorado River is a unique ecosystem and provides important ecological services such as habitat for fish species as well as water power energy supplies. River management for this ecosystem requires assessment and decision support tools for fish which involves protecting, restoring as well as the forecasting of future conditions. In this paper, a habitat and population model was developed and used to determine the levels of fish habitat suitability and population density in Colorado River between Lees Ferry and Lake Mead...
February 22, 2018: Mathematical Biosciences
Abbas Alshami, Joseph Varon
No abstract text is available yet for this article.
February 21, 2018: Resuscitation
Hyung Ki Moon, Jinhee Jang, Kyu Nam Park, Soo Hyun Kim, Byung Kook Lee, Sang Hoon Oh, Kyung Woon Jeung, Seung Pill Choi, In Soo Cho, Chun Song Youn
INTRODUCTION: Predicting neurologic outcomes after cardiac arrest (CA) is challenging. This study tested the hypothesis that a quantitative analysis of diffusion weighted imaging (DWI) using the FMRIB Software Library (FSL) can predict neurologic outcomes after CA and can clarify the optimal apparent diffusion coefficient (ADC) thresholds for predicting poor neurologic outcomes. METHODS: Out-of-hospital CA patients treated with targeted temperature management (TTM) who underwent DWI were included in this study...
February 21, 2018: Resuscitation
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