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Hypothermia for neurologic disease

Michael W Hubble, Clark Tyson
: Introduction Vasopressors are associated with return of spontaneous circulation (ROSC), but no long-term benefit has been demonstrated in randomized trials. However, these trials did not control for the timing of vasopressor administration which may influence outcomes. Consequently, the objective of this study was to develop a model describing the likelihood of favorable neurological outcome (cerebral performance category [CPC] 1 or 2) as a function of the public safety answering point call receipt (PSAP)-to-pressor-interval (PPI) in prolonged out-of-hospital cardiac arrest...
February 22, 2017: Prehospital and Disaster Medicine
Aimee I Porter, Rebecca A Erwin-Cohen, Nancy Twenhafel, Taylor Chance, Steven B Yee, Steven J Kern, David Norwood, Laurie J Hartman, Michael D Parker, Pamela J Glass, Luis DaSilva
BACKGROUND: Licensed antiviral therapeutics and vaccines to protect against eastern equine encephalitis virus (EEEV) in humans currently do not exist. Animal models that faithfully recapitulate the clinical characteristics of human EEEV encephalitic disease, including fever, drowsiness, anorexia, and neurological signs such as seizures, are needed to satisfy requirements of the Food and Drug Administration (FDA) for clinical product licensing under the Animal Rule. METHODS: In an effort to meet this requirement, we estimated the median lethal dose and described the pathogenesis of aerosolized EEEV in the common marmoset (Callithrix jacchus)...
February 7, 2017: Virology Journal
Luca Vedovelli, Massimo Padalino, Sara D'Aronco, Giovanni Stellin, Carlo Ori, Virgilio P Carnielli, Manuela Simonato, Paola Cogo
OBJECTIVES: Improved congenital heart defect (CHD) operations have reduced operative mortality to 3%. The major concern is now long-term neurological outcomes. We measured plasma glial fibrillary acidic protein (GFAP), an early marker of brain injury, during different phases of cardiopulmonary bypass (CPB), to correlate the increase of GFAP to clinical parameters or specific operative phases. METHODS: We performed a prospective, single-centre, observational study in children undergoing cardiac operations...
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
Arzu Antal Dönmez, Taylan Adademir, Hakan Sacli, Cengiz Koksal, Mete Alp
Objective: This study aims to compare three different surgical approaches for combined coronary and carotid artery stenosis as a single stage procedure and to assess effect of operative strategy on mortality and neurological complications. Methods: This retrospective study involves 136 patients who had synchronous coronary artery revascularization and carotid endarterectomy in our institution, between January 2002 and December 2012. Patients were divided into 3 groups according to the surgical technique used...
September 2016: Brazilian Journal of Cardiovascular Surgery
Nodu Shivananda Gautham, Appavoo Arulvelan, Sethuraman Manikandan
Polycythemia vera (PV) is a myeloproliferative disorder characterized by excess red cell clonality. The increased number of red blood cells can lead to increased viscosity of the blood and ultimately compromise the blood supply to the end organs. Thromboembolic and hemorrhagic complications can also develop. Patients with PV presenting with neurological diseases that require surgical intervention are at an increased risk due to various factors, such as immobility, prolonged surgical time, hypothermia and dehydration...
October 2016: Journal of Anesthesia
Ourania Preventza, Andrea Garcia, Sarang A Kashyap, Shahab Akvan, Denton A Cooley, Kiki Simpson, Athina Rammou, Matt D Price, Shuab Omer, Faisal G Bakaeen, Lorraine D Cornwell, Joseph S Coselli
OBJECTIVES: To determine whether, in patients with previous cardiac operations, moderate hypothermia (between 24 and 28°C) for hypothermic circulatory arrest (HCA) during antegrade cerebral perfusion (ACP) is safe for use during surgery on the proximal aorta and transverse aortic arch. METHODS: Over a 7-year period, 118 patients underwent ascending aortic and hemiarch repair (n = 70; 59.3%), total arch replacement (n = 47; 39.8%) or ascending aortic replacement to treat porcelain aorta (n = 1; 0...
November 2016: European Journal of Cardio-thoracic Surgery
Ediz Tasan, Michael E Jesinger, Richard J Charnigo, Sage P Kramer, Sooyeon Kim, Linda Clements, Alison L Bailey, Charles L Campbell
The American Heart Association recommends therapeutic hypothermia for comatose patients with return of spontaneous circulation after out-of-hospital ventricular fibrillation cardiac arrest. While there is a growing body of evidence for the general efficacy of therapeutic hypothermia, the individualized benefit of therapy is not currently predictable. Ninety-one consecutive patients, from April 2011 to July 2014, were treated at the University of Kentucky Medical Center with the therapeutic hypothermia protocol...
August 2016: Therapeutic Hypothermia and Temperature Management
Muhammad Kashif, Hafiz Rizwan Talib Hashmi, Misbahuddin Khaja
Foreign body aspiration (FBA) is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA)...
2016: Case Reports in Critical Care
Michael S Merrill, Catherine M Wares, Alan C Heffner, Kenneth L Shauger, H James Norton, Michael S Runyon, David A Pearson
BACKGROUND: Recent advances in post-cardiac arrest (CA) care including therapeutic hypothermia (TH) have improved survival and favorable neurologic outcomes for survivors of CA. Survivors often present with deep coma and lack of brainstem reflexes, which are generally associated with adverse outcomes in many disease processes. Little is known regarding the role of initial emergency department (ED) neurological examination and its potential for prognostication. OBJECTIVES: The purpose of this study is to determine if components of a standardized neurologic examination are reliable prognosticators in patients recently resuscitated from CA...
June 2016: American Journal of Emergency Medicine
Marco Cirillo
Acute dissection of the ascending aorta is a life-threatening condition in which the aortic wall develops one or more tears of the intima associated with intramural rupture of the media layer with subsequent formation of a two lumina vessel. The remaining outer layer is just the adventitia, with high risk of complete rupture. Vital organs may be under-perfused. Mortality rate in this acute event is about 50% if an emergent surgical procedure is not performed as soon as possible to replace the tract affected by the primary rupture...
April 2016: Medical Hypotheses
Mark S Wainwright, Gregory Hansen, Juan Piantino
PURPOSE OF REVIEW: Approximately one in five children admitted to a pediatric ICU have a new central nervous system injury or a neurological complication of their critical illness. The spectrum of neurologic insults in children is diverse and clinical practice is largely empirical, as few randomized, controlled trials have been reported. This lack of data poses a substantial challenge to the practice of pediatric neurocritical care (PNCC). PNCC has emerged as a novel subspecialty, and its presence is expanding within tertiary care centers...
April 2016: Current Opinion in Critical Care
Xi-Chun May Lu, Deborah A Shear, Ying Deng-Bryant, Lai Yee Leung, Guo Wei, Zhiyong Chen, Frank C Tortella
Brain hypothermia has been considered as a promising alternative to whole-body hypothermia in treating acute neurological disease, for example, traumatic brain injury. Previously, we demonstrated that 2-hours selective brain cooling (SBC) effectively mitigated acute (≤24 hours postinjury) neurophysiological dysfunction induced by a penetrating ballistic-like brain injury (PBBI) in rats. This study evaluated neuroprotective effects of extended SBC (4 or 8 hours in duration) on sub-acute secondary injuries between 3 and 21 days postinjury (DPI)...
March 2016: Therapeutic Hypothermia and Temperature Management
Mervyn Maze
PURPOSE: The purpose of this report is to facilitate an understanding of the possible application of xenon for neuroprotection in critical care settings. This narrative review appraises the literature assessing the efficacy and safety of xenon in preclinical models of acute ongoing neurologic injury. SOURCE: Databases of the published literature (MEDLINE® and EMBASE™) were appraised for peer-reviewed manuscripts addressing the use of xenon in both preclinical models and disease states of acute ongoing neurologic injury...
February 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Mathias Forkmann, Steffen Kolschmann, Luise Holzhauser, Karim Ibrahim, Michael Guenther, Marian Christoph, Joerg T Fuhrmann, Alessandra Boscheri, Alexander Schmeiβer, Ruth H Strasser, Carsten Wunderlich
BACKGROUND: Accumulating evidence indicates that target temperature management (TTM) is beneficial in patients resuscitated after cardiac arrest since it appears to improve neurological outcome. However, the optimal cooling method (surface vs. intravascular) has not yet been specified. Substantial heart disease is present in most of these patients and therefore haemodynamic effects of cooling need to be considered very carefully. We analysed the haemodynamic response to TTM in patients treated with surface versus intravascular cooling following out-of-hospital cardiac arrest...
August 2015: Acta Cardiologica
David M Greer
PURPOSE OF REVIEW: Neuroprognostication following cardiac arrest is a common and challenging dilemma for neurologists and intensivists, complicated by the use of therapeutic hypothermia and targeted temperature management. Great advances have been made in understanding the mechanisms of disorders of consciousness in hypoxic-ischemic brain injury, and new diagnostic and therapeutic avenues are arising. RECENT FINDINGS: In the era of therapeutic hypothermia and targeted temperature management, traditional clinical signs, electrophysiologic findings, and chemical biomarkers have now become questionable or variable, and the proper time for diagnostic and prognostic testing has become murky...
October 2015: Continuum: Lifelong Learning in Neurology
Leda Nobile, Irene Lamanna, Vito Fontana, Katia Donadello, Antonio Maria Dell'anna, Jacques Creteur, Jean-Louis Vincent, Federico Pappalardo, Fabio Silvio Taccone
AIM: Spontaneous alterations in temperature homeostasis after cardiac arrest (CA) are associated with worse outcome. However, it remains unclear the prognostic role of temperature variability (TV) during cooling procedures. We hypothesized that low TV during targeted temperature management (TTM) would be associated with a favourable neurological outcome after CA. METHODS: We reviewed data from all comatose patients after in-hospital or out-of-hospital CA admitted to our Department of Intensive Care between December 2006 and January 2014 who underwent TTM (32-34°C) and survived at least 24h...
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
Nicolas Deye, Alain Cariou, Patrick Girardie, Nicolas Pichon, Bruno Megarbane, Philippe Midez, Jean-Marie Tonnelier, Thierry Boulain, Hervé Outin, Arnaud Delahaye, Aurélie Cravoisy, Alain Mercat, Pascal Blanc, Charles Santré, Hervé Quintard, François Brivet, Julien Charpentier, Delphine Garrigue, Bruno Francois, Jean-Pierre Quenot, François Vincent, Pierre-Yves Gueugniaud, Jean-Paul Mira, Pierre Carli, Eric Vicaut, Frédéric J Baud
BACKGROUND: Targeted temperature management is recommended after out-of-hospital cardiac arrest. Whether advanced internal cooling is superior to basic external cooling remains unknown. The aim of this multicenter, controlled trial was to evaluate the benefit of endovascular versus basic surface cooling. METHODS AND RESULTS: Inclusion criteria were the following: age of 18 to 79 years, out-of-hospital cardiac arrest related to a presumed cardiac cause, time to return of spontaneous circulation <60 minutes, delay between return of spontaneous circulation and inclusion <240 minutes, and unconscious patient after return of spontaneous circulation and before the start of cooling...
July 21, 2015: Circulation
Omar Choudhri, Aatman Shah, Jennifer Basarab-Tung, Richard A Jaffe, Gary K Steinberg
The authors describe the case of a 51-year-old man with bilateral moyamoya disease and prior strokes who developed an asystolic cardiac arrest while undergoing revascularization surgery under mild hypothermia. The patient was successfully treated with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) after manual cardiopulmonary resuscitation (CPR) was unsuccessful for 45 minutes. ECMO is a cardiopulmonary support system that is indicated for respiratory failure in pediatric and adult patients. It is increasingly being used as an extension to mechanical CPR for patients who have suffered cardiac arrest if the underlying cause of cardiac arrest is thought to be reversible...
September 2015: Journal of Neurosurgery
Robert Newmyer, Jenny Mendelson, Diana Pang, Ericka L Fink
Acute central nervous system conditions due to hypoxic-ischemic encephalopathy, traumatic brain injury (TBI), status epilepticus, and central nervous system infection/inflammation, are a leading cause of death and disability in childhood. There is a critical need for effective neuroprotective therapies to improve outcome targeting distinct disease pathology. Fever, defined as patient temperature > 38°C, has been clearly shown to exacerbate brain injury. Therapeutic hypothermia (HT) is an intervention using targeted temperature management that has multiple mechanisms of action and robust evidence of efficacy in multiple experimental models of brain injury...
March 1, 2015: Current Treatment Options in Pediatrics
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