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Post arrest cooling

Kacey B Anderson, Samuel M Poloyac, Patrick M Kochanek, Philip E Empey
Targeted temperature management (TTM) has been shown to reduce mortality and improve neurological outcomes in out-of-hospital cardiac arrest (CA) patients and in neonates with hypoxic-ischemic encephalopathy (HIE). TTM has also been associated with adverse drug events in the critically ill patient due to its effect on drug pharmacokinetics (PKs) and pharmacodynamics (PDs). We aim to evaluate the current literature on the effect of TTM on drug PKs and PDs following CA. MEDLINE/PubMed databases were searched for publications, which include the MeSH terms hypothermia, drug metabolism, drug transport, P450, critical care, cardiac arrest, hypoxic-ischemic encephalopathy, pharmacokinetics, and pharmacodynamics between July 2006 and October 2015...
September 13, 2016: Therapeutic Hypothermia and Temperature Management
Taeyun Kim, Michael G Paine, He Meng, Ren Xiaodan, Jacob Cohen, Tulasi Jinka, Huiyong Zheng, James A Cranford, Robert W Neumar
AIM: Post-cardiac arrest hypothermic-targeted temperature management (HTTM) improves outcomes in preclinical cardiac arrest studies. However, inadequate understanding of the mechanisms and therapeutic windows remains a barrier to optimization. We tested the hypothesis that combined intra- and post-cardiac arrest HTTM provides a synergistic outcome benefit compared to either strategy alone. METHODS: Rats subjected to 8-min asphyxial cardiac arrest were block randomized to 4 treatment groups (n=12/group): NTTM) normothermic-targeted temperature management; 1-24 HTTM) HTTM initiated 1h post-ROSC and maintained for 24h; Intra-1 HTTM) HTTM initiated at CPR onset and maintained for 1h; and Intra-24 HTTM) HTTM initiated at CPR onset and maintained for 24h...
October 2016: Resuscitation
Sevtap Hekimoğlu Şahin, Mustafa İnan, Burhan Aksu, Naci Öner, Alkin Çolak, Ahmet Güzel
Malignant hyperthermia (MH) is a rare and potentially life threatening fatal complication of anaesthesia. We present a 2-year-old boy with late onset MH after colon interposition to replace the oesophagus under sevoflurane anaesthesia. The patient was treated with intravenous dantrolene sodium as well as cooling and controlled ventilation. Despite treatment, the patient developed cardiopulmonary arrest at 21 hours after the operation and died. It should be kept in mind that post-operative MH may develop during these types of operations with ischaemia-reperfusion injuries...
December 2015: Turkish Journal of Anaesthesiology and Reanimation
Michaël Sage, Mathieu Nadeau, Matthias Kohlhauer, Jean-Paul Praud, Renaud Tissier, Raymond Robert, Hervé Walti, Philippe Micheau
Ultra-fast cooling for mild therapeutic hypothermia (MTH) has several potential applications, including prevention of post-cardiac arrest syndrome. Ultra-fast MTH by total liquid ventilation (TLV) entails the sudden filling of the lungs with a cold perfluorocarbon liquid and its subsequent use to perform TLV. The present physiological study was aimed at assessing whether pulmonary and systemic hemodynamics as well as lung mechanics are significantly altered during this procedure. Pulmonary and systemic arterial pressures, cardiac output as well as airway resistance and respiratory system compliance were measured during ultra-fast MTH by TLV followed by rewarming and normothermia in six healthy juvenile lambs...
August 2016: Cryobiology
Silvia De Rosa, Massimo Antonelli, Claudio Ronco
Cellular damage after reperfusion of ischaemic tissue is defined as ischaemia-reperfusion injury (IRI). Hypothermia is able to decrease oxygen consumption, preventing a rapid loss of mitochondrial activity. However, even though cooling can help to decrease the deleterious effects of ischaemia, the consequences are not exclusively beneficial, such that hypothermic storage is a compromise between benefits and harm. The present review details the relationship between renal IRI and hypothermia, describing the pathophysiology of IRI and hypothermic protection through experimental evidence...
April 6, 2016: Nephrology, Dialysis, Transplantation
Ines Ponz, Esteban Lopez-de-Sa, Eduardo Armada, Juan Caro, Zorba Blazquez, Sandra Rosillo, Oscar Gonzalez, Juan Ramon Rey, Maria Del Carmen Monedero, Jose Luis Lopez-Sendon
INTRODUCTION: Target temperature management (TTM) has shown to reduce brain damage after an out-of-hospital cardiac arrest (CA), but the time to neurological recovery is not defined yet. We sought to determine the time these patients need to regain consciousness, as well as factors associated with a late post-arrest awakening. METHODS: We performed a retrospective analysis of patients cooled to 32-34°C during 24h after CA, who regained neurological responsiveness after rewarming...
June 2016: Resuscitation
Andrej Markota, Jure Fluher, Barbara Kit, Petra Balažič, Andreja Sinkovič
BACKGROUND: Temperature management is a recommended part of post-resuscitation care of comatose survivors of cardiac arrest. A number of methods exist for temperature management, all of which have limitations. We aimed to evaluate the performance and ease of use of a new esophageal heat transfer device (EHTD; Advanced Cooling Therapy, Chicago, IL, USA) for temperature management of adult survivors of cardiac arrest. METHODS: We performed a prospective study from March to June 2015...
April 2016: American Journal of Emergency Medicine
Alejandro A Rabinstein
Neurological recovery often determines outcome in patients resuscitated after cardiac arrest. Temperature control as a neuroprotective strategy has become standard of care. The first randomized trials showing improved neurological outcomes in patients treated with hypothermia with a target temperature of 33°C over a decade ago led to the inclusion of this intervention in practice guidelines and the broad adoption of hypothermia protocols across the world. More recently, large randomized trials showed no difference from targeting a temperature of 33 or 36°C and no benefit from pre-hospital induction of hypothermia...
February 2016: Seminars in Respiratory and Critical Care Medicine
Derek DeLia, Henry E Wang, Jared Kutzin, Mark Merlin, Jose Nova, Kristen Lloyd, Joel C Cantor
BACKGROUND: Clinical trials supporting the use of therapeutic hypothermia (TH) in the treatment of out-of-hospital cardiac arrest (OHCA) are based on small patient samples and do not reflect the wide variation in patient selection, cooling methods, and other elements of post-arrest care that are used in everyday practice. This study provides a real world evaluation of the effectiveness of post-arrest care in TH centers during a time of growing TH dissemination in the state of New Jersey (NJ)...
2015: BMC Health Services Research
Jens Christmann, Lale Azer, Daniel Dörr, Günter R Fuhr, Philippe I H Bastiaens, Frank Wehner
Slow cooling leads to a passive dehydration of cells, whereas rehydration during warming reflects the active regain of functionality. The ability to modulate such an energy demanding process could be instrumental in optimizing the cryo-arrest of living systems. In the present study, various levels of hypertonic stress were used to disturb the water content of cells and to define the energy profiles of aquaporins and (Na(+) conducting) cation channels during rehydration. Na(+) import was found to be the rate-limiting step in water restoration, whereas aquaporins merely played a permissive role...
March 15, 2016: Journal of Physiology
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
Ahmed F Hegazy, Danielle M Lapierre, Ron Butler, Eyad Althenayan
BACKGROUND: Mild hypothermia and fever control have been shown to improve neurological outcomes post cardiac arrest. Common methods to induce hypothermia include body surface cooling and intravascular cooling; however, a new approach using an esophageal cooling catheter has recently become available. METHODS: We report the first three cases of temperature control using an esophageal cooling device (ECD). The ECD was placed in a similar fashion to orogastric tubes...
2015: BMC Anesthesiology
Michael W Donnino, Lars W Andersen, Katherine M Berg, Joshua C Reynolds, Jerry P Nolan, Peter T Morley, Eddy Lang, Michael N Cocchi, Theodoros Xanthos, Clifton W Callaway, Jasmeet Soar
For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C...
January 2016: Resuscitation
Teiji Oda, Akane Yamaguchi, Koji Shimizu, Tetsuro Nikai, Ken-ichi Matsumoto
BACKGROUND: Hypothermia is utilized in cardiac and aortic surgery to protect organs from ischemic reperfusion injury. Although the cooled body is invariably rewarmed after the procedure, it is still unknown whether the rewarmed body regains its former biological state. This study determined the modulatory effects of hypothermia on the human myocardial proteome and whether subsequent rewarming restores the proteome to the state prior to cooling. METHODS AND RESULTS: A quantitative proteomic analysis was performed using isobaric tags for relative and absolute quantification labeling tandem mass spectrometry...
2015: Circulation Journal: Official Journal of the Japanese Circulation Society
Saurabh Saigal, Jai Prakash Sharma, Ritika Dhurwe, Sanjay Kumar, Mohan Gurjar
Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21(st) century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings...
September 2015: Indian Journal of Critical Care Medicine
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
Young-Min Kim, Chun Song Youn, Soo Hyun Kim, Byung Kook Lee, In Soo Cho, Gyu Chong Cho, Kyung Woon Jeung, Sang Hoon Oh, Seung Pill Choi, Jong Hwan Shin, Kyoung-Chul Cha, Joo Suk Oh, Hyeon Woo Yim, Kyu Nam Park
INTRODUCTION: The aim of this study was to investigate the association of adverse events (AEs) during targeted temperature management (TTM) and other AEs and concomitant treatments during the advanced critical care period with poor neurological outcome at hospital discharge in adult out-of-hospital cardiac arrest (OHCA) patients. METHODS: This was a retrospective study using Korean Hypothermia Network registry data of adult OHCA patients treated with TTM in 24 teaching hospitals throughout South Korea from 2007 to 2012...
2015: Critical Care: the Official Journal of the Critical Care Forum
Matthias Kohlhauer, Fanny Lidouren, Isabelle Remy-Jouet, Nicolas Mongardon, Clovis Adam, Patrick Bruneval, Hakim Hocini, Yves Levy, Fabiola Blengio, Pierre Carli, Benoit Vivien, Jean-Damien Ricard, Philippe Micheau, Hervé Walti, Mathieu Nadeau, Raymond Robert, Vincent Richard, Paul Mulder, David Maresca, Charlie Demené, Mathieu Pernot, Mickael Tanter, Bijan Ghaleh, Alain Berdeaux, Renaud Tissier
OBJECTIVES: Total liquid ventilation provides ultrafast and potently neuro- and cardioprotective cooling after shockable cardiac arrest and myocardial infarction in animals. Our goal was to decipher the effect of hypothermic total liquid ventilation on the systemic and cerebral response to asphyxial cardiac arrest using an original pressure- and volume-controlled ventilation strategy in rabbits. DESIGN: Randomized animal study. SETTING: Academic research laboratory...
October 2015: Critical Care Medicine
Eric M Schenfeld, Jonathan Studnek, Alan C Heffner, Marcy Nussbaum, Kathi Kraft, David A Pearson
OBJECTIVE: Despite growing adoption, the impact of prehospital initiation of therapeutic hypothermia on outcomes of cardiac arrest patients is unknown. The objective of this study was to determine if prehospital administration of cold intravenous fluids improved the time-to-target temperature. METHODS: All patients enrolled in an institutional post- cardiac arrest treatment pathway were prospectively registered into a quality assurance database. Patients undergoing cooling induction on hospital arrival were compared to those receiving a new treatment protocol initiated during the study period involving prehospital cooling with 4°C (39...
May 2015: CJEM
Sarah Baos, Karen Sheehan, Lucy Culliford, Katie Pike, Lucy Ellis, Andrew J Parry, Serban Stoica, Mohamed T Ghorbel, Massimo Caputo, Chris A Rogers
BACKGROUND: During open heart surgery, patients are connected to a heart-lung bypass machine that pumps blood around the body ("perfusion") while the heart is stopped. Typically the blood is cooled during this procedure ("hypothermia") and warmed to normal body temperature once the operation has been completed. The main rationale for "whole body cooling" is to protect organs such as the brain, kidneys, lungs, and heart from injury during bypass by reducing the body's metabolic rate and decreasing oxygen consumption...
2015: JMIR Research Protocols
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