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Therapeutic Hypothermia, ROSC, post cardiac arrest

Jose A Adams, Arkady Uryash, Vinay Nadkarni, Robert A Berg, Jose R Lopez
AIMS: Heart rate variability (HRV) is a measure of the balance between the sympathetic and parasympathetic autonomic nervous system and lack thereof an ominous sign in many cardiac and neurological conditions including post-cardiac arrest syndrome. Whole body periodic acceleration (pGz) has been shown to be cardio protective when applied prior to during and after cardiac arrest (CA). Here, we investigate whether or not pGz pre or post treatment after CA preserves HRV. METHODS: Eight min of unsupported ventricular fibrillation followed by CPR and defibrillation was carried out in 32 anesthetized and paralyzed male swine who were randomized to pretreatment (1h pGz prior to CA, pre-pGz [n=8]) or post-treatment (pGz beginning at 30min after return of spontaneous circulation ([ROSC], post-pGz [n=8]) or none (CONT [n=8])...
February 2016: Resuscitation
Aiham Albaeni, Shaker M Eid, Bolanle Akinyele, Lekshmi Narayan Kurup, Dhananjay Vaidya, Nisha Chandra-Strobos
AIMS: to explore the association between post return of spontaneous circulation (ROSC) hemoglobin level and survival with good neurological outcome following out-of-hospital cardiac arrest. METHODS: We studied adults with non-traumatic out-of-hospital cardiac arrest who achieved ROSC within 50min of collapse. We quantified the association between post ROSC hemoglobin level and good neurological outcome (defined as Cerebral Performance Category score of 1or 2), using multivariate logistic regression analyses...
February 2016: Resuscitation
Pei Wang, Lei Zhang, Yushun Gong, Hehua Zhang, Xiang Wang, Yongqin Li
BACKGROUND: Systemic hypertension and left ventricular hypertrophy (LVH) are major risk factors of cardiac arrest. However, the impacts of hypertension and LVH on the outcome of cardiopulmonary resuscitation (CPR) and post-resuscitation hypothermia are still undetermined. METHODS: After 4 min of untreated ventricular fibrillation (VF) and 4 min of CPR, defibrillation was attempted in 16 male spontaneously hypertensive rats (SHR) with LVH and 16 male normotensive Wistar Kyoto (WKY) rats...
April 2016: Shock
(no author information available yet)
BACKGROUND: Little is known about recent changes in pre- and in-hospital treatments and outcomes for elderly patients with out-of-hospital cardiac arrest (OHCA). METHODS: We compared data collected for the SOS-KANTO study in 2002 and 2012. We included patients aged ≥65 years who experienced OHCA of cardiac aetiology. The primary endpoint was favourable neurological outcomes 1 month after cardiac arrest. RESULTS: A total of 8,964 (2002 vs...
December 2015: Resuscitation
Vimal Ramjee, Anne V Grossestreuer, Yuan Yao, Sarah M Perman, Marion Leary, James N Kirkpatrick, Paul R Forfia, Daniel M Kolansky, Benjamin S Abella, David F Gaieski
OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction. METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012...
November 2015: Resuscitation
Robert J Gajarski, Kurtis Smitko, Renee Despres, Jeff Meden, David W Hutton
OBJECTIVES: Using survival and neurologic outcome as endpoints , this study explored the incremental cost effectiveness of three mutually exclusive cooling strategies employed after resuscitated out-of-hospital cardiac arrests. DESIGN: Economic analysis based on retrospective data collection and Markov modeling. SETTING: Modeling based on patients housed in a tertiary ICU setting. PATIENTS: Patients >18 years following resuscitation from out-of-hospital cardiac arrest...
2015: SpringerPlus
Kei Nishiyama, Noritoshi Ito, Tomohiko Orita, Kei Hayashida, Hideki Arimoto, Satoru Beppu, Mitsuru Abe, Takashi Unoki, Tomoyuki Endo, Akira Murai, Takeshi Hatada, Noriaki Yamada, Masahiro Mizobuchi, Hideo Himeno, Kazuo Okuchi, Hideto Yasuda, Toshiaki Mochizuki, Kazuhiro Shiga, Migaku Kikuchi, Yuka Tsujimura, Tetsuo Hatanaka, Ken Nagao
AIM: This study investigated the value of regional cerebral oxygen saturation (rSO2) monitoring upon arrival at the hospital for predicting post-cardiac arrest intervention outcomes. METHODS: We enrolled 1195 patients with out-of-hospital cardiac arrest of presumed cardiac cause from the Japan-Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry. The primary endpoint was a good neurologic outcome (cerebral performance categories 1 or 2 [CPC1/2]) 90 days post-event...
November 2015: Resuscitation
Gene Sung, Nichole Bosson, Amy H Kaji, Mark Eckstein, David Shavelle, William J French, Joseph L Thomas, William Koenig, James T Niemann
OBJECTIVE: Therapeutic hypothermia (TH) improves neurologic outcome in patients resuscitated from ventricular fibrillation. The purpose of this study was to evaluate TH effects on neurologic outcome in patients resuscitated from a non-shockable out-of-hospital cardiac arrest rhythm. DESIGN AND SETTING: This is a retrospective cohort study of data reported to a registry in an emergency medical system in a large metropolitan region. Patients achieving field return of spontaneous circulation are transported to designated hospitals with TH protocols...
February 2016: Neurocritical Care
Eric Cortez, Ashish R Panchal, James Davis, Paul Zeeb, David P Keseg
INTRODUCTION: Recent studies have brought to question the efficacy of the use of prehospital therapeutic hypothermia for victims of out-of-hospital cardiac arrest (OHCA). Though guidelines recommend therapeutic hypothermia as a critical link in the chain of survival, the safety of this intervention, with the possibility of minimal treatment benefit, becomes important. Hypothesis/Problem This study examined prehospital therapeutic hypothermia for OHCA, its association with survival, and its complication profile in a large, metropolitan, fire-based Emergency Medical Services (EMS) system, where bystander cardiopulmonary resuscitation (CPR) and post-arrest care are in the process of being optimized...
October 2015: Prehospital and Disaster Medicine
Tadashi Kaneko, Shunji Kasaoka, Takashi Nakahara, Hirotaka Sawano, Yoshio Tahara, Mamoru Hase, Kenji Nishioka, Shinichi Shirai, Hiroshi Hazui, Hideki Arimoto, Kazunori Kashiwase, Tomokazu Motomura, Yasuhiro Kuroda, Yuji Yasuga, Naohiro Yonemoto, Hiroyuki Yokoyama, Ken Nagao, Hiroshi Nonogi
BACKGROUND: Therapeutic hypothermia (TH) is a standard strategy to reduce brain damage in post-cardiac arrest syndrome (PCAS) patients. However, it is unknown whether the target temperature should be adjusted for PCAS patients in different states. METHODS: Participants in the J-PULSE-Hypo study database were divided into lower (32.0-33.5 °C; Group L) or moderate (34.0-35.0 °C; Group M) temperature groups. Primary outcome was a favourable neurological outcome (proportion of patients with a Glasgow-Pittsburgh Cerebral Performance Category [CPC] of 1-2 on day 30)...
2015: Journal of Intensive Care
Bob Smit, Angelique M E Spoelstra-de Man, Armand R J Girbes, Monique C de Waard
BACKGROUND: In spite of the introduction of mild therapeutic hypothermia (MTH), mortality rates remain high in patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA). To date, no accurate and independent biomarker to predict survival in these patients exists. B-type natriuretic peptide (BNP) was found to provide both prognostic and diagnostic value in various cardiovascular diseases, including survival to hospital discharge in patients with ROSC. However, the biologically inactive counterpart of BNP, NT-proBNP, was found to be a more stable and accurate analyte...
2015: BMC Anesthesiology
Gregor Broessner, Julia Hasslacher, Ronny Beer, Peter Lackner, Georg Franz Lehner, Ulrich Harler, Alois Schiefecker, Raimund Helbok, Bettina Pfausler, Angelika Hammerer-Lercher, Michael Joannidis
OBJECTIVE: To evaluate the prognostic potential of serum C-terminal provasopressin (CT-proAVP or Copeptin) and midregional pro-A-type natriuretic peptide (MR-proANP) to predict neurological outcome following resuscitation from cardiac arrest. METHODS: In this prospective observational study, we employed novel ultra sensitive immunoassay technology to examine serial serum samples from 134 cardiac arrest patients. Patients were either allocated to mild therapeutic hypothermia using an endovascular device or normothermia...
April 2015: Resuscitation
Willard W Sharp, David G Beiser, Yong Hu Fang, Mei Han, Lin Piao, Justin Varughese, Stephen L Archer
OBJECTIVES: Survival following sudden cardiac arrest is poor despite advances in cardiopulmonary resuscitation and the use of therapeutic hypothermia. Dynamin-related protein 1, a regulator of mitochondrial fission, is an important determinant of reactive oxygen species generation, myocardial necrosis, and left ventricular function following ischemia/reperfusion injury, but its role in cardiac arrest is unknown. We hypothesized that dynamin-related protein 1 inhibition would improve survival, cardiac hemodynamics, and mitochondrial function in an in vivo model of cardiac arrest...
February 2015: Critical Care Medicine
Hyuk Jun Yang, Gi Woon Kim, Hyun Kim, Jin Seong Cho, Tai Ho Rho, Han Deok Yoon, Mi Jin Lee
Sudden cardiac death (SCD) is a significant issue affecting national health policies. The National Emergency Department Information System for Cardiac Arrest (NEDIS-CA) consortium managed a prospective registry of out-of-hospital cardiac arrest (OHCA) at the emergency department (ED) level. We analyzed the NEDIS-CA data from 29 participating hospitals from January 2008 to July 2009. The primary outcomes were incidence of OHCA and final survival outcomes at discharge. Factors influencing survival outcomes were assessed as secondary outcomes...
January 2015: Journal of Korean Medical Science
Ya-Jie Zhang, Meng-Jun Wu, Yi Li, Hai Yu
Although improvement in cardiopulmonary resuscitation (CPR) performance and the increasing success at achieving return of spontaneous circulation (ROSC) have been possible in recent years, the survival and discharge rates of post-cardiac arrest (CA) patients remain disappointing. The high mortality rate is attributed to whole-body ischemia/reperfusion (I/R) induced multi-organ dysfunction that is well known as post-cardiac arrest syndrome. Post-cardiac arrest myocardial dysfunction and brain injury are the main clinical features of this complex pathophysiological process...
January 2015: Medical Hypotheses
Dermot Maher, Huy Tran, Miriam Nuno, Dawn Eliashiv, Taizoon Yusufali, Nicholas D'Attellis, Jeffrey Chung
INTRODUCTION: Therapeutic hypothermia (TH) after cardiac arrest (CA) resuscitation is the first therapy proven to increase survival to discharge and neurologic recovery. Methods for neurologic and mortality prognostication after CA resuscitation have been called into question because they were developed based on evidence that was developed prior to the advent of TH. This study examines the relationship between electroencephalogram (EEG) patterns and mortality and neurologic outcomes in post-CA patients undergoing TH...
February 2015: Journal of Critical Care
Sarah M Perman, Jonas H Ellenberg, Anne V Grossestreuer, David F Gaieski, Marion Leary, Benjamin S Abella, Brendan G Carr
INTRODUCTION: Time to achieve target temperature varies substantially for patients who undergo targeted temperature management (TTM) after cardiac arrest. The association between arrival at target temperature and neurologic outcome is poorly understood. We hypothesized that shorter time from initiation of cooling to target temperature ("induction") will be associated with worse neurologic outcome, reflecting more profound underlying brain injury and impaired thermoregulatory control. METHODS: This was a multicenter retrospective study analyzing data from the Penn Alliance for Therapeutic Hypothermia (PATH) Registry...
March 2015: Resuscitation
Dominique Biarent, Christine Fonteyne, Ariane Willems, Audrey Dupont
Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation in children, many of the children do not survive to discharge because they developped a post cardiac arrest syndrome. The post-cardiac arrest syndrome includes systemic ischaemia/reperfusion response, post-cardiac arrest brain injury, postcardiac arrest myocardial dysfunction, and persistent precipitating pathology. The main cause of death after ROSC in children is brain injury. Physiopathology and management are reviewed in regards of pediatric specificities...
2013: Current Pediatric Reviews
Cecilia Gómez Ravetti, Tatiana Oliveira Silva, Anselmo Dornas Moura, Frederico Bruzzi de Carvalho
OBJECTIVE: To determine the characteristics of patients undergoing standard institutional protocol for management of resuscitated patients after a cardiac arrest episode, including therapeutic hypothermia. METHODS: This was a retrospective analysis of 26 consecutive patients admitted following cardiac arrest, between January 2007 and November 2008. RESULTS: All cases underwent therapeutic hypothermia. Average age was 63 years, and the patients were predominantly male...
December 2009: Revista Brasileira de Terapia Intensiva
Gilson Soares Feitosa-Filho, Joberto Pinheiro Sena, Hélio Penna Guimarães, Renato Delascio Lopes
Cardiac arrest survivors frequently suffer from ischemic brain injury associated with poor neurological outcome and death. Therapeutic hypothermia improves outcomes in comatose survivors after resuscitation from out-of-hospital cardiac arrest. Considering its formal recommendation as a therapy, post-return of spontaneous circulation after cardiac arrest, the objective of this study was to review the clinical aspects of therapeutic hypothermia. Non-systematic review of articles using the keywords "cardiac arrest, cardiopulmonary resuscitation, cooling, hypothermia, post resuscitation syndrome" in the Med-Line database was performed...
March 2009: Revista Brasileira de Terapia Intensiva
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