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ROSC hypothermia

Emily K Zern, Michael N Young, Taylor Triana, Meng Xu, Benjamin Holmes, Nyal Borges, John A McPherson, Mohana B Karlekar
BACKGROUND: Palliative care (PC) services are integral to the care of patients with advanced medical illnesses. Given the significant morbidity and mortality associated with cardiac arrest, we sought to measure the use and impact of PC in the care of patients treated with therapeutic hypothermia (TH). METHODS: We conducted a retrospective study of 317 consecutive patients undergoing TH after cardiac arrest. We compared intensive care unit (ICU) characteristics and clinical outcomes of subjects who received PC consultation (n=125) to those who did not (n=192)...
December 21, 2016: Resuscitation
Robert B Schock, Andreas Janata, W Frank Peacock, Nathan S Deal, Sarathi Kalra, Fritz Sterz
Our purpose was to analyze evidence related to timing of cooling from studies of targeted temperature management (TTM) after return of spontaneous circulation (ROSC) after cardiac arrest and to recommend directions for future therapy optimization. We conducted a preliminary review of studies of both animals and patients treated with post-ROSC TTM and hypothesized that a more rapid cooling strategy in the absence of volume-adding cold infusions would provide improved outcomes in comparison with slower cooling...
December 2016: Therapeutic Hypothermia and Temperature Management
Katie Zanyk-McLean, Kelly N Sawyer, Ryan Paternoster, Rebekah Shievitz, William Devlin, Robert Swor
Post cardiac arrest, neuroprognostication remains a complex and clinically challenging issue for critical care providers. For this reason, our primary objective in this study was to determine the frequency of survival and favorable neurological outcomes in post-cardiac arrest patients with delayed time to awakening. To assess whether early withdrawal of care may adversely impact survival, we also sought to describe the time to withdrawal of care of non-surviving patients. We performed a retrospective study of patients resuscitated after cardiac arrest in two large academic community hospitals...
November 18, 2016: Therapeutic Hypothermia and Temperature Management
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
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
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
Stephen A Bernard, Karen Smith, Judith Finn, Cindy Hein, Hugh Grantham, Janet E Bray, Conor Deasy, Michael Stephenson, Teresa A Williams, Lahn D Straney, Deon Brink, Richard Larsen, Chris Cotton, Peter Cameron
BACKGROUND: Patients successfully resuscitated by paramedics from out-of-hospital cardiac arrest often have severe neurologic injury. Laboratory and observational clinical reports have suggested that induction of therapeutic hypothermia during cardiopulmonary resuscitation (CPR) may improve neurologic outcomes. One technique for induction of mild therapeutic hypothermia during CPR is a rapid infusion of large-volume cold crystalloid fluid. METHODS: In this multicenter, randomized, controlled trial we assigned adults with out-of-hospital cardiac arrest undergoing CPR to either a rapid intravenous infusion of up to 2 L of cold saline or standard care...
September 13, 2016: Circulation
Catarina Ruivo, Célia Jesus, João Morais, Paula Viana
INTRODUCTION AND OBJECTIVES: Therapeutic hypothermia (TH) is recommended for patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA). There is still uncertainty about management, target temperature and duration of TH. In the present study we aim to describe the initial experience of a non-tertiary care center with TH after CA and to determine predictors of mortality. METHODS: During the period 2011-2014, out of 2279 patients hospitalized in the intensive care unit, 82 had a diagnosis of CA with ROSC...
July 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Kazuhiro Sugiyama, Masahiro Kashiura, Akiko Akashi, Takahiro Tanabe, Yuichi Hamabe
BACKGROUND: The early prediction of neurological outcomes in postcardiac arrest patients treated with therapeutic hypothermia (TH) remains challenging. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG. A particular cutoff time from the return of spontaneous circulation (ROSC) to the recovery of a normal aEEG trace for predicting a good neurological outcome has not yet been established. The purpose of the present study was to examine the relation between neurological outcomes and the continuous normal voltage (CNV) recovery time in adult comatose survivors of cardiac arrest treated with TH and identify the recovery time cutoff for predicting a good neurological outcome...
2016: Journal of Intensive Care
Lin Wu, He-Liang Sun, Yu Gao, Kang-Li Hui, Miao-Miao Xu, Hao Zhong, Man-Lin Duan
Therapeutic hypothermia is well known for its protective effect against brain injury after cardiac arrest, but the exact mechanism remains unclear. Cold-inducible RNA-binding protein (CIRP), a member of cold shock protein, enables mammalian cells to withstand decreased temperature by regulating gene translation. However, the role of CIRP in global cerebral ischemia after therapeutic hypothermia has not been clearly elucidated. In the present study, rats resuscitated from 4 min of cardiac arrest were separately treated with therapeutic hypothermia (immediately after return of spontaneous circulation (ROSC); targeted temperature at 33 °C) and therapeutic normothermia (targeted temperature at 36...
March 19, 2016: Molecular Neurobiology
Kerry A Benson-Cooper
AIM: To determine the association between use of therapeutic hypothermia (TH) after resuscitation from out-of-hospital cardiac arrest (OHCA) and neurological outcome. METHOD: Retrospective observational cohort study in a tertiary university-associated Level III general ICU of 179 ICU patients in three cohorts ('pre' hypothermia: 58 patients, 'post' hypothermia 69 patients, 'recent' 52 patients) admitted between 1 January, 2009, and 15 April, 2011, after resuscitation from OHCA...
December 18, 2015: New Zealand Medical Journal
Nichole E Bosson, Amy H Kaji, William J Koenig, James T Niemann
Old age is considered a negative prognostic factor after out-of-hospital cardiac arrest (OHCA). The purpose of this study was to assess the benefit of therapeutic hypothermia (TH) on survival and neurologic outcome in the elderly. This is a retrospective study of patients treated for OHCA from April 2011 to August 2013 in a regional cardiac system. Patients with return of spontaneous circulation (ROSC) are directed to designated cardiac receiving centers with established TH protocols. The decision to initiate TH is determined by the treating physician...
June 2016: Therapeutic Hypothermia and Temperature Management
Shuichi Hagiwara
Many emergency physicians struggle with the clinical question of whether to perform therapeutic hypothermia (TH) or coronary angiography (CAG) first after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). We analyzed the results of the SOS-KANTO 2012 study, which is a prospective, multicenter (67 emergency hospitals), observational study about OHCA conducted between January 2012 and March 2013 (n = 16,452). We compared two groups: the group in which TH was first performed (TH group), and the group in which CAG was performed first (CAG group) within 24 h after arrival...
June 2016: Internal and Emergency Medicine
A S Sharma, R W M Pijls, P W Weerwind, T S R Delnoij, W C de Jong, A P M Gorgels, J G Maessen
AIM: The current outcome of out-of-hospital cardiac arrest (OHCA) patients in the Maastricht region was analysed with the prospect of implementing extracorporeal cardiopulmonary resuscitation (E-CPR). METHODS: A retrospective analysis of adult patients who were resuscitated for OHCA during a 24-month period was performed. RESULTS: 195 patients (age 66 [57-75] years, 82 % male) were resuscitated for OHCA by the emergency medical services and survived to admission at the emergency department...
February 2016: Netherlands Heart Journal
Andreas Günther, Ulf Harding, Matthias Gietzelt, Frank Gradaus, Erik Tute, Matthias Fischer
INTRODUCTION: Due to limited resources, the 2010 European Resuscitation Council (ERC) guidelines could not be fully implemented in the Emergency Medical Services (EMS) of Brunswick, Germany. This is why implementation was prioritized according to local conditions. Thus, prehospital therapeutic hypothermia, mechanical chest compression and feedback systems were not established. Clinical data and long-term results were assessed by a QM system and room for improvement was identified. METHODS: All attempted resuscitations from 2011 until 2014 were recorded and compared against the German Resuscitation Registry...
2015: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
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
Leah Bergman, Justin B Lundbye
Cardiac arrest (CA) often results in hemodynamic and metabolic compromise with associated poor prognosis. Therapeutic hypothermia (TH) has become the standard of care for CA survivors, decreasing reperfusion injury and intercellular acid-base disturbances, with improved neurologic outcomes. These benefits are realized despite a mild acidosis that can potentially occur during TH. By contrast, the severity of acidosis after return of spontaneous circulation (ROSC) must be monitored carefully and managed appropriately...
December 2015: Best Practice & Research. Clinical Anaesthesiology
Pratik Doshi, Kishan Patel, Rosa Banuelos, Bryan Darger, Steven Baker, Kimberly A Chambers, Manoj Thangam, Keith Gates
OBJECTIVES: Therapeutic hypothermia has been shown to improve neurologic outcome and survival in out-of-hospital cardiac arrest (OHCA) following return of spontaneous circulation (ROSC), and current guidelines recommend therapeutic hypothermia for all comatose survivors of OHCA. However, recommendations for nonshockable rhythms are not as strongly supported. Our study aims to provide further evidence on the use of therapeutic hypothermia in nonshockable rhythms. METHODS: A multivariate analysis with propensity score matching was performed using a cardiac arrest registry maintained by the Houston Fire Department...
January 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Adrien Bouglé, Fabrice Daviaud, Wulfran Bougouin, Aurore Rodrigues, Guillaume Geri, Tristan Morichau-Beauchant, Lionel Lamhaut, Florence Dumas, Alain Cariou
AIM OF THE STUDY: To study the determinants and the evolution of cerebral oximetry determined by near-infrared spectroscopy after out-of-hospital cardiac arrest of cardiac origin during therapeutic hypothermia and rewarming, and to compare cerebral oximetry values between patients with good and bad prognosis. METHODS: In this prospective, non-interventional, single center study, all consecutive patients between 18 and 80 years admitted for out-of-hospital cardiac arrest (OHCA) with a no flow less than 10min, a low flow of less than 50min and a persistent coma after ROSC with Glasgow score equal or less than seven at baseline were included...
February 2016: Resuscitation
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