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Hypothermia after cardiac arrest

Guillaume Geri, Guillaume Savary, Stéphane Legriel, Florence Dumas, Sybille Merceron, Olivier Varenne, Bernard Livarek, Olivier Richard, Jean-Paul Mira, Jean-Pierre Bedos, Jean-Philippe Empana, Alain Cariou, David Grimaldi
BACKGROUND: Obesity prevalence has dramatically increased over recent years and is associated with cardiovascular diseases, but data are lacking on its prognostic impact in out-of-hospital cardiac arrest (OHCA) patients. METHODS: Data of all consecutive OHCA patients admitted in two cardiac arrest centers from Paris and suburbs between 2005 and 2012 were prospectively collected. Patients treated by therapeutic hypothermia (TH) were included in the analysis. Logistic and Cox regression analyses were used to quantify the association between Body Mass Index (BMI) at hospital admission and day-30 and 1-year mortality respectively...
October 12, 2016: Resuscitation
Kathleen Meert, Russell Telford, Richard Holubkov, Beth S Slomine, James R Christensen, J Michael Dean, Frank W Moler
OBJECTIVE: To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial. METHODS: Fifty-four infants (48h to <1year of age) with ALTE who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation were included...
October 11, 2016: Resuscitation
Paul S Chan, Robert A Berg, Yuanyuan Tang, Lesley H Curtis, John A Spertus
Importance: Therapeutic hypothermia is used for patients following both out-of-hospital and in-hospital cardiac arrest. However, randomized trials on its efficacy for the in-hospital setting do not exist, and comparative effectiveness data are limited. Objective: To evaluate the association between therapeutic hypothermia and survival after in-hospital cardiac arrest. Design, Setting, and Patients: In this cohort study, within the national Get With the Guidelines-Resuscitation registry, 26 183 patients successfully resuscitated from an in-hospital cardiac arrest between March 1, 2002, and December 31, 2014, and either treated or not treated with hypothermia at 355 US hospitals were identified...
October 4, 2016: JAMA: the Journal of the American Medical Association
Jiří Bonaventura, David Alan, Jiri Vejvoda, Jakub Honek, Josef Veselka
In spite of many years of development and implementation of pre-hospital advanced life support programmes, the survival rate of out-of-hospital cardiac arrest (OHCA) used to be very poor. Neurologic injury from cerebral hypoxia is the most common cause of death in patients with OHCA. In the past two decades, post-resuscitation care has developed many new concepts aimed at improving the neurological outcome and survival rate of patients after cardiac arrest. Systematic post-cardiac arrest care after the return of spontaneous circulation, including induced mild therapeutic hypothermia (TH) in selected patients, is aimed at significantly improving rates of long-term neurologically intact survival...
October 1, 2016: Archives of Medical Science: AMS
Yan Wang, Jian Song, Yuhong Liu, Yaqiang Li, Zhengxin Liu
BACKGROUND The purpose of this study was to determine the effect of mild hypothermia therapy on gastric mucosa after cardiopulmonary resuscitation (CPR) and the underlying mechanism. MATERIAL AND METHODS Ventricular fibrillation was induced in pigs. After CPR, the surviving pigs were divided into mild hypothermia-treated and control groups. The changes in vital signs and hemodynamic parameters were monitored before cardiac arrest and at intervals of 0.5, 1, 2, 4, 6, 12, and 24 h after restoration of spontaneous circulation...
October 3, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Kathleen L Meert, Russell Telford, Richard Holubkov, Beth S Slomine, James R Christensen, J Michael Dean, Frank W Moler
OBJECTIVE: To investigate relationships between cardiac arrest characteristics and survival and neurobehavioral outcome among children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. DESIGN: Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial data. SETTING: Thirty-six PICUs in the United States and Canada. PATIENTS: All children (n = 295) had chest compressions for greater than or equal to 2 minutes, were comatose, and required mechanical ventilation after return of circulation...
September 27, 2016: Pediatric Critical Care Medicine
Chaoran Nie, Jiaxu Dong, Pengjiao Zhang, Xintong Liu, Fei Han
BACKGROUND: The effectiveness and safety of the infusion of ice-cold fluids for prehospital hypothermia in cardiac arrest victims are unclear. This study assessed its effects in adult victims of out-of-hospital cardiac arrest. METHODS: An online search of PubMed and Cochrane Library databases was performed. Cooling methods were limited to ice-cold fluid perfusion. Randomized controlled trials were included in this review. The main outcomes were body temperature at hospital arrival, survival to hospital discharge, neurological recovery, incidence of pulmonary edema, and the rate of rearrest...
September 6, 2016: American Journal of Emergency Medicine
Julianna Jung
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 2016: Emergency Medicine Practice
Karl Sporer, Michael Jacobs, Leo Derevin, Sue Duval, James Pointer
OBJECTIVE: To assess system-wide implementation of specific therapies focused on perfusion during cardiopulmonary resuscitation (CPR) and cerebral recovery after Return of Spontaneous Circulation (ROSC). METHODS: Before and after retrospective analysis of an out-of-hospital cardiac arrest database. Implementation trial in the urban/suburban community of Alameda County, California, USA, population 1.6 million, from November 2009-December 2012. Adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA) who received CPR and/or defibrillation...
September 14, 2016: Prehospital Emergency Care
Antonio Maria Dell'anna, Julia Bini Viotti, Marjorie Beumier, Diego Orbegozo-Cortes, Katia Donadello, Sabino Scolletta, Jean-Louis Vincent, Fabio Silvio Taccone
No abstract text is available yet for this article.
September 7, 2016: Resuscitation
Neeraj Shah, Rahul Chaudhary, Kathan Mehta, Vratika Agarwal, Jalaj Garg, Ronald Freudenberger, Larry Jacobs, David Cox, Karl B Kern, Nainesh Patel
OBJECTIVES: This study sought to determine whether "real-world" data supported the hypothesis that therapeutic hypothermia (TH) led to increased rates of stent thrombosis. BACKGROUND: TH, which is often instituted after cardiac arrest (CA) to improve neurologic outcomes, alters pharmacokinetics of antiplatelet medications, leading to a theoretical risk of stent thrombosis after percutaneous coronary intervention (PCI). METHODS: CA patients with acute myocardial infarction undergoing PCI were identified from the Nationwide Inpatient Sample from 2006 to 2011, with a defined primary outcome of stent thrombosis...
September 12, 2016: JACC. Cardiovascular Interventions
Jeong Ho Park, Ki Ok Ahn, Sang Do Shin, Kyoung Jun Song, Young Sun Ro, Joo Yong Kim, Eui Jung Lee, Yu Jin Lee
AIM: To provide therapeutic hypothermia (TH) to survivors after out-of-hospital cardiac arrest (OHCA), inter-hospital transfers (IHT) are frequently required. The safety of IHT remains controversial. The aim of this study was to investigate whether the effect of TH on brain recovery after OHCA differs between IHT and direct arrival groups. METHODS: We identified patients with OHCA of presumed cardiac aetiology who were resuscitated by emergency medical services and experienced return-of-spontaneous circulation in 27 hospitals between January and December 2014...
August 31, 2016: Resuscitation
Joerg C Schefold, Nora Fritschi, Gerhard Fusch, Aldin Bahonjic, Wolfram Doehner, Stephan von Haehling, Rene Pschowski, Christian Storm, Tim Schroeder
BACKGROUND/AIMS: Temperature control improves neurological prognosis in comatose cardiac arrest (CA) survivors. Previous reports demonstrate that most affected patients show signs of significant systemic inflammation. In an effort to better characterize potential temperature-related effects on key inflammatory pathways, we investigate the course of Tryptophan (Trp) levels, Tryptophan catabolites (including kynurenines) and indoleamine-2,3-dioxygenase (IDO)-activity in post CA patients...
October 2016: Resuscitation
Jacquelyn Adams, Jose R Cepeda Brito, Lauren Baker, Patrick G Hughes, M David Gothard, Michele L McCarroll, Jocelyn Davis, Angela Silber, Rami A Ahmed
Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations...
2016: Critical Care Research and Practice
Sulagna Bhattacharjee, Dalim K Baidya, Souvik Maitra
BACKGROUND: Cardiac arrest is associated with very high mortality and causes neurological dysfunction in the survivors. Therapeutic hypothermia is one of the recommended modality in the postarrest management. However, recent findings question its benefit in postarrest management. This meta-analysis has been conceptualized to quantify clinical benefit of therapeutic hypothermia in post-cardiac arrest patients. METHODS: Prospective, randomized, and quasi-randomized controlled trials comparing the efficacy of therapeutic hypothermia in post-cardiac arrest adult population with a post-cardiac arrest management protocol that does not include therapeutic hypothermia were included in this meta-analysis...
September 2016: Journal of Clinical Anesthesia
Nicholas J Johnson, Babette Rosselot, Sarah M Perman, Kalani Dodampahala, Munish Goyal, David F Gaieski, Anne V Grossestreuer
PURPOSE: The purpose of the study is to determine the association between hemoglobin concentration (Hgb) and neurologic outcome in postarrest patients. METHODS: We conducted a retrospective cohort study using the Penn Alliance for Therapeutic Hypothermia (PATH) cardiac arrest registry. Inclusion criteria were resuscitated cardiac arrest (inhospital or out of hospital) and an Hgb value recorded within 24 hours of return of spontaneous circulation. The primary outcome was favorable neurologic status at hospital discharge...
July 17, 2016: Journal of Critical Care
Aldo L Schenone, Aaron Cohen, Gabriel Patarroyo, Logan Harper, XiaoFeng Wang, Mehdi H Shishehbor, Venu Menon, Abhijit Duggal
AIMS OF THE STUDY: We aimed to determine the benefit of an expanded use of TH. We also described the impact of a targeted temperature management on outcomes at discharge. DATA SOURCES: We identified studies by searching MEDLINE, EMBASE and Cochrane Library databases. We included RCTs and observational studiesrestricted to those reporting achieved temperature during TH after OHCA. No other patient, cardiac arrest or hypothermia protocol restrictions were applied...
August 10, 2016: Resuscitation
Faye S Silverstein, Beth S Slomine, James Christensen, Richard Holubkov, Kent Page, J Michael Dean, Frank W Moler
OBJECTIVES: To analyze functional performance measures collected prospectively during the conduct of a clinical trial that enrolled children (up to age 18 yr old), resuscitated after out-of-hospital cardiac arrest, who were at high risk of poor outcomes. DESIGN: Children with Glasgow Motor Scale score less than 5, within 6 hours of resuscitation, were enrolled in a clinical trial that compared two targeted temperature management interventions (THAPCA-OH, NCT00878644)...
August 9, 2016: Critical Care Medicine
Matthew T Niehaus, Rita M Pechulis, James K Wu, Steven Frei, John J Hong, Rovinder S Sandhu, Marna Rayl Greenberg
Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use...
October 2016: Prehospital and Disaster Medicine
Daniel Brevoord, Charlotte J P Beurskens, Walter M van den Bergh, Wim K Lagrand, Nicole P Juffermans, Jan M Binnekade, Benedikt Preckel, Janneke Horn
AIM: Besides supportive care, the only recommended treatment for comatose patients after cardiac arrest is target temperature management. Helium reduces ischaemic injury in animal models, and might ameliorate neurological injury in patients after cardiac arrest. As no studies exist on the use of helium in patients after cardiac arrest we investigated whether this is safe and feasible. METHODS: The study was an open-label single arm intervention study in a mixed-bed academic intensive care unit...
October 2016: Resuscitation
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