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Hypothermia after cardiac arrest

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https://www.readbyqxmd.com/read/28634504/the-reemergence-of-eeg-reactivity-after-cardiac-arrest
#1
Joseph Zachariah, Alejandro A Rabinstein
Electroencephalogram (EEG) reactivity has been increasingly utilized in prognostication after cardiac arrest. Recent studies have demonstrated a false-positive rate of 0% in predicting poor outcome with a nonreactive EEG. The reemergence of reactivity after an initial nonreactive EEG has been noted in cases of drug intoxication, rewarming after hypothermia, and after discontinuing sedation. This is the first case describing the reemergence of EEG reactivity without the confounding factors listed above. We describe a case of resuscitated cardiac arrest with initial EEG demonstrating a lack of reactivity...
July 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28631089/targeted-temperature-management-in-the-icu-guidelines-from-a-french-expert-panel
#2
REVIEW
Alain Cariou, Jean-François Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28622752/microvascular-fluid-exchange-during-cpb-with-deep-hypothermia-circulatory-arrest-or-low-flow
#3
Bjørg Elvevoll, Paul Husby, Venny L Kvalheim, Lodve Stangeland, Arve Mongstad, Øyvind S Svendsen
OBJECTIVE: Use of deep hypothermic low-flow (DHLF) cardiopulmonary bypass (CPB) has been associated with higher fluid loading than the use of deep hypothermia circulatory arrest (DHCA). We evaluated whether these perfusion strategies influenced fluid extravasation rates and edema generation differently per-operatively. MATERIALS AND METHODS: Twelve anesthetized pigs, randomly allocated to DHLF (n = 6) or DHCA (n = 6), underwent 2.5 hours CPB with cooling to 20°C for 30 minutes (min), followed by 30 min arrested circulation (DHCA) or 30 min low-flow circulation (DHLF) before 90 min rewarming to normothermia...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28592725/useful-computed-tomography-score-for-estimation-of-early-neurologic-outcome-in-post-cardiac-arrest-patients-with-therapeutic-hypothermia
#4
Kyu Sun Lee, Sung Eun Lee, Jun Young Choi, Yu-Rha Gho, Minjung Kathy Chae, Eun Jung Park, Mun Hee Choi, Ji Man Hong
BACKGROUND: The Alberta Stroke Program Early CT Score (ASPECTS) is used to assess early ischemic stroke damage. This study compared bilateral ASPECTS (ASPECTS-b) with the gray:white matter ratio (GWR) and quantitative regional abnormality (QRA) to evaluate the prognostic utility of early computed tomography (CT) findings in post-cardiac arrest patients.Methods and Results:Out-of-hospital cardiac arrest patients with return of spontaneous circulation (ROSC) who underwent brain CT (<6 h after onset) and therapeutic hypothermia were recruited from a university hospital over a 2-year period...
June 6, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28581447/time-window-is-important-for-adenosine-preventing-cold-induced-injury-to-the-endothelium
#5
Yan Li, Xiao-Xia Hu, Li Fu, Jing Chen, Li-He Lu, Xiang Liu, Zhe Xu, Li Zhou, Zhi-Ping Wang, Xi Zhang, Zhi-Jun Ou, Jing-Song Ou
Cold cardioplegia is used to induce heart arrest during cardiac surgery. However, endothelial function may be compromised after this procedure. Accordingly, interventions such as adenosine, that mimic the effects of preconditioning, may minimize endothelial injury. Herein, we investigated whether adenosine prevents cold-induced injury to the endothelium. Cultured human cardiac microvascular endothelial cells were treated with adenosine for different durations. Phosphorylation and expression of endothelial nitric oxide synthase (eNOS), p38MAPK, ERK1/2, and p70S6K6 were measured along with nitric oxide (NO) production using diaminofluorescein-2 diacetate (DAF-2DA) probe...
June 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28579371/influence-of-argon-on-temperature-modulation-and-neurological-outcome-in-hypothermia-treated-rats-following-cardiac-arrest
#6
Anne Brücken, Christian Bleilevens, Philipp Föhr, Kay Nolte, Rolf Rossaint, Gernot Marx, Michael Fries, Matthias Derwall
AIM OF THE STUDY: Combining xenon and mild therapeutic hypothermia (MTH) after cardiac arrest (CA) confers a degree of protection that is greater than either of the two interventions alone. However, xenon is very costly which might preclude a widespread use. We investigated whether the inexpensive gas argon would enhance hypothermia induced neurologic recovery in a similar manner. METHODS: Following nine minutes of CA and three minutes of cardiopulmonary resuscitation 21 male Sprague-Dawley rats were randomized to receive MTH (33°C for 6h), MTH plus argon (70% for 1h), or no treatment...
June 1, 2017: Resuscitation
https://www.readbyqxmd.com/read/28573043/a-safety-evaluation-of-profound-hypothermia-induced-suspended-animation-for-delayed-resuscitation-at-90-or-120%C3%A2-min
#7
Yu Liu, Shu Li, Zhi Li, Jian Zhang, Jin-Song Han, Yong Zhang, Zong-Tao Yin, Hui-Shan Wang
BACKGROUND: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia-induced suspended animation for delayed resuscitation (SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest (CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals...
2017: Military Medical Research
https://www.readbyqxmd.com/read/28562481/extracorporeal-life-support-increases-survival-after-prolonged-ventricular-fibrillation-cardiac-arrest-in-the-rat
#8
Ingrid Anna Maria Magnet, Florian Ettl, Andreas Schober, Alexandra-Maria Warenits, Daniel Grassmann, Michael Wagner, Christoph Schriefl, Christian Clodi, Ursula Teubenbacher, Sandra Högler, Wolfgang Weihs, Fritz Sterz, Andreas Janata
BACKGROUND: Extracorporeal life support (ECLS) for cardiopulmonary resuscitation (CPR) may increase end organ perfusion and thus survival when conventional CPR fails. The aim was to investigate, if after ventricular fibrillation cardiac arrest in rodents ECLS improves outcome compared to conventional CPR. METHODS: In 24 adult male Sprague-Dawley rats (460 to 510 g) resuscitation was started after 10 min of no-flow with ECLS (consisting of an open reservoir, roller pump and membrane oxygenator, connected to a cannulas in the jugular vein and femoral artery, n = 8) or CPR (mechanical chest compressions plus ventilations, n = 8) and compared to a sham group (n = 8)...
May 29, 2017: Shock
https://www.readbyqxmd.com/read/28557905/ssep-in-therapeutic-hypothermia-era
#9
Carolina B Maciel, Adeolu O Morawo, Ching Y Tsao, Teddy S Youn, Douglas R Labar, Elayna O Rubens, David M Greer
PURPOSE: The reliability of somatosensory evoked potentials (SSEPs) in predicting outcome in comatose survivors of cardiac arrest treated with therapeutic hypothermia (TH) has been questioned. We investigated whether the absence of cortical (N20) responses was a reliable predictor of a nonawakening in the setting of TH. METHODS: A retrospective review was conducted in cardiac arrest survivors treated with TH admitted to a single tertiary care hospital from April, 2010 to March, 2013 who underwent SSEP testing at various time points after cardiac arrest...
May 25, 2017: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
https://www.readbyqxmd.com/read/28553435/therapeutic-hypothermia-reduces-oxidative-damage-and-alters-antioxidant-defenses-after-cardiac-arrest
#10
Fernanda S Hackenhaar, Tássia M Medeiros, Fernanda M Heemann, Camile S Behling, Jordana S Putti, Camila D Mahl, Cleber Verona, Ana Carolina A da Silva, Maria C Guerra, Carlos A S Gonçalves, Vanessa M Oliveira, Diego F M Riveiro, Silvia R R Vieira, Mara S Benfato
After cardiac arrest, organ damage consequent to ischemia-reperfusion has been attributed to oxidative stress. Mild therapeutic hypothermia has been applied to reduce this damage, and it may reduce oxidative damage as well. This study aimed to compare oxidative damage and antioxidant defenses in patients treated with controlled normothermia versus mild therapeutic hypothermia during postcardiac arrest syndrome. The sample consisted of 31 patients under controlled normothermia (36°C) and 11 patients treated with 24 h mild therapeutic hypothermia (33°C), victims of in- or out-of-hospital cardiac arrest...
2017: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/28552462/the-accuracy-of-picco%C3%A2-in-measuring-cardiac-output-in-patients-under-therapeutic-hypothermia-comparison-with-transthoracic-echocardiography
#11
T Souto Moura, S Aguiar Rosa, N Germano, R Cavaco, T Sequeira, M Alves, A L Papoila, L Bento
BACKGROUND: Invasive cardiac monitoring using thermodilution methods such as PiCCO® is widely used in critically ill patients and provides a wide range of hemodynamic variables, including cardiac output (CO). However, in post-cardiac arrest patients subjected to therapeutic hypothermia, the low body temperature possibly could interfere with the technique. Transthoracic Doppler echocardiography (ECHO) has long proved its accuracy in estimating CO, and is not influenced by temperature changes...
May 25, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28521971/comparison-of-early-sequential-hypothermia-and-delayed-hypothermia-on-neurological-function-after-resuscitation-in-a-swine-model
#12
Wei Yuan, Jun-Yuan Wu, Yong-Zhen Zhao, Jie Li, Jie-Bin Li, Zhen-Hua Li, Chun-Sheng Li
BACKGROUND: We utilized a porcine cardiac arrest model to compare early sequential hypothermia (ESH) with delayed hypothermia (DH) and no hypothermia (NH) to investigate the different effects on cerebral function after resuscitation. METHODS: After return of spontaneous circulation (ROSC), resuscitated 24 pigs divided into three groups. The ESH group implemented early sequential hypothermia immediately, and the DH group implemented delayed hypothermia at 1 h after ROSC...
May 11, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28513117/routine-laboratory-indices-as-predictor-of-neurological-recovery-in-post-resuscitation-syndrome-patients-treated-with-therapeutic-hypothermia
#13
Sa'ar Minha, Tali Taraboulos, Gabby Elbaz-Greener, Eran Kalmanovich, Zvi Vered, Alex Blatt
BACKGROUND: Hypothermia is associated with improved outcome in selected survivors of cardiac arrest but no single metric enables proper prediction of neurological outcome. OBJECTIVES: To explored the association between routine laboratory indices of patients treated by hypothermia for cardiac arrest and their neurological outcome. METHODS: We retrospectively collected data from survivors of cardiac arrest treated with hypothermia for 24 hours and grouped them according to their neurological outcome to either "poor" or "favorable"...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28508339/induction-of-hibernation-like-hypothermia-by-central-activation-of-the-a1-adenosine-receptor-in-a-non-hibernator-the-rat
#14
Hiroki Shimaoka, Takayuki Kawaguchi, Kahori Morikawa, Yuuki Sano, Kiyotada Naitou, Hiroyuki Nakamori, Takahiko Shiina, Yasutake Shimizu
Central adenosine A1-receptor (A1AR)-mediated signals play a role in the induction of hibernation. We determined whether activation of the central A1AR enables rats to maintain normal sinus rhythm even after their body temperature has decreased to less than 20 °C. Intracerebroventricular injection of an adenosine A1 agonist, N6-cyclohexyladenosine (CHA), followed by cooling decreased the body temperature of rats to less than 20 °C. Normal sinus rhythm was fundamentally maintained during the extreme hypothermia...
May 15, 2017: Journal of Physiological Sciences: JPS
https://www.readbyqxmd.com/read/28506940/cool-ami-eu-pilot-trial-a-multicentre-prospective-randomised-controlled-trial-to-assess-cooling-as-an-adjunctive-therapy-to-percutaneous-intervention-in-patients-with-acute-myocardial-infarction
#15
Marko Noc, David Erlinge, Aleksandar N Neskovic, Srdjan Kafedzic, Béla Merkely, Endre Zima, Misa Fister, Milovan Petrović, Milenko Čanković, Gábor Veress, Peep Laanmets, Teele Pern, Vladan Vukcevic, Vladimir Dedovic, Beata Średniawa, Andrzej Świątkowski, Thomas R Keeble, John R Davies, Alexandra-Maria Warenits, Göran Olivecrona, Jan Zbigniew Peruga, Michal Ciszewski, Ivan Horvath, Istvan Edes, Gergely Gyorgy Nagy, Daniel Aradi, Michael Holzer
AIMS: We aimed to investigate the rapid induction of therapeutic hypothermia using the ZOLL Proteus Intravascular Temperature Management System in patients with anterior ST-elevation myocardial infarction (STEMI) without cardiac arrest. METHODS AND RESULTS: A total of 50 patients were randomised; 22 patients (88%; 95% confidence interval [CI]: 69-97%) in the hypothermia group and 23 patients (92%; 95% CI: 74-99) in the control group completed cardiac magnetic resonance imaging at four to six days and 30-day follow-up...
May 17, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28495952/deep-and-profound-hypothermia-in-haemorrhagic-shock-friend-or-foe-a-systematic-review
#16
REVIEW
Samuel E Moffatt, S J B Mitchell, J L Walke
INTRODUCTION: Survival in exsanguinating cardiac arrest patients is poor, as is neurological outcome in survivors. Hypothermia has traditionally been seen as harmful to trauma patients and associated with increased mortality; however, there has been speculation that cooling to very low temperatures (≤20°C) could be used to treat haemorrhagic trauma patients by the induction of a suspended animation period through extreme cooling, which improves survival and preserves neurological function...
May 11, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28490655/practice-guideline-summary-reducing-brain-injury-following-cardiopulmonary-resuscitation-report-of-the-guideline-development-dissemination-and-implementation-subcommittee-of-the-american-academy-of-neurology
#17
Romergryko G Geocadin, Eelco Wijdicks, Melissa J Armstrong, Maxwell Damian, Stephan A Mayer, Joseph P Ornato, Alejandro Rabinstein, José I Suarez, Michel T Torbey, Richard M Dubinsky, Jason Lazarou
OBJECTIVE: To assess the evidence and make evidence-based recommendations for acute interventions to reduce brain injury in adult patients who are comatose after successful cardiopulmonary resuscitation. METHODS: Published literature from 1966 to August 29, 2016, was reviewed with evidence-based classification of relevant articles. RESULTS AND RECOMMENDATIONS: For patients who are comatose in whom the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32-34°C for 24 hours) is highly likely to be effective in improving functional neurologic outcome and survival compared with non-TH and should be offered (Level A)...
May 30, 2017: Neurology
https://www.readbyqxmd.com/read/28490379/a-novel-scoring-system-for-predicting-the-neurologic-prognosis-prior-to-the-initiation-of-induced-hypothermia-in-cases-of-post-cardiac-arrest-syndrome-the-cast-score
#18
Mitsuaki Nishikimi, Naoyuki Matsuda, Kota Matsui, Kunihiko Takahashi, Tadashi Ejima, Keibun Liu, Takayuki Ogura, Michiko Higashi, Hitoshi Umino, Go Makishi, Atsushi Numaguchi, Satoru Matsushima, Hideki Tokuyama, Mitsunobu Nakamura, Shigeyuki Matsui
BACKGROUND: The aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome (PCAS) patients with a good potential for recovery prior to the initiation of induced therapeutic hypothermia. METHODS: A multi-center, retrospective, observational study was performed. Data of a total of 151 consecutive adults who underwent induced hypothermia after cardiac arrest (77 learning cases from two hospitals and 74 validation cases from two other hospitals) were analyzed...
May 10, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28481829/a-population-pharmacokinetic-analysis-to-study-the-effect-of-therapeutic-hypothermia-on-vancomycin-disposition-in-children-resuscitated-from-cardiac-arrest
#19
Nicole R Zane, Michael D Reedy, Marc R Gastonguay, Adam S Himebauch, Evan Z Ramsey, Alexis A Topjian, Athena F Zuppa
OBJECTIVES: Limited data exist on the effects of therapeutic hypothermia on renal function and pharmacokinetics in pediatric patients after cardiac arrest. The objective was to describe the differences in vancomycin disposition in pediatric patients following cardiac arrest treated with either therapeutic hypothermia or normothermia using population pharmacokinetic modeling. DESIGN: Single-center, retrospective cohort study. SETTING: A tertiary care hospital pediatric and cardiac ICU...
May 5, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28466294/-cardiac-support-and-replacement-systems
#20
REVIEW
T Graf, H Thiele
In recent years, the widespread use of partial mechanical cardiac support and even temporary complete replacement of cardiac function has been established in many intensive care units in the treatment of refractory cardiogenic shock. There is a difference between partial left-ventricular assist devices (LVAD) and the possibility of complete heart (and lung) replacement by extra corporeal life support (ECLS). Despite the use of mechanical support devices, the mortality of cardiogenic shock remains high. The consideration of using percutaneous LVAD and ECLS in cardiogenic shock should be considered in refractory cardiogenic shock patients in addition to support by catecholamines and after early revascularization in acute coronary syndromes...
June 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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