Correlation between initial serum levels of lactate after return of spontaneous circulation and survival and neurological outcomes in patients who undergo therapeutic hypothermia after cardiac arrest

Resuscitation ◽  
2015 ◽  
Vol 88 ◽  
pp. 143-149 ◽  
Author(s):  
Dong Hoon Lee ◽  
In Soo Cho ◽  
Sun Hwa Lee ◽  
Yong Il Min ◽  
Jin Hong Min ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Serum Levels ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes

scholarly journals Timing of inducing therapeutic hypothermia in patients successfully resuscitated after out-of-hospital cardiac arrest

2020 ◽  
pp. 102490792095856
Author(s):  
Doo Youp Kim ◽  
Jin Sup Park ◽  
Sun Hak Lee ◽  
Jeong Cheon Choe ◽  
Jin Hee Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Therapeutic Hypothermia ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background: Therapeutic hypothermia can improve neurological status in cardiac arrest survivors. Objectives: We investigated the association between the timing of inducing therapeutic hypothermia and neurological outcomes in patients who experienced out-of-hospital cardiac arrest. Methods: We evaluated data from 116 patients who were comatose after return of spontaneous circulation and those who received therapeutic hypothermia between January 2013 and April 2017. The primary endpoint was good neurological outcomes during index hospitalization, defined as a cerebral performance category score of 1 or 2. Therapeutic hypothermia timing was defined as the duration from the return of spontaneous circulation to hypothermia initiation. We analyzed the effect of early hypothermia induction on neurological results. Results: In total, 112 patients were enrolled. The median duration to hypothermia initiation was 284 min (25th–75th percentile, 171–418 min). Eighty-two (69.5%) patients underwent hypothermia within 6 h, and 30 (25.4%) had good neurological outcomes. The rates of good neurological outcomes by hypothermia initiation time quartile (shortest to longest) were 28.3%, 34.5%, 14.8%, and 28.6% (p = 0.401). The good neurologic outcomes did not differ between hypothermia patients within 6 h or after (26.5% vs 26.7%, p = 0.986). Short low-flow time and bystander resuscitation were associated with good neurological outcomes (p = 0.044, confidence interval: 0.027–0.955), but the timing of hypothermia initiation was not (p = 0.602, confidence interval: 0.622–1.317). Conclusion: A shorter low-flow time was associated with good neurological outcomes in out-of-hospital cardiac arrest patients who experienced hypothermia. However, inducing hypothermia sooner, even within 6 h, did not improve the neurological outcomes. Thus, as current guidelines recommend, initiating hypothermia within 6 h of recovery of spontaneous circulation is reasonable.

Systemic inflammation at 24 h predicts outcome in patients after out-of-hospital cardiac arrest treated with therapeutic hypothermia

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A5.3-A6
Author(s):  
Gareth Clegg
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Systemic Inflammation ◽  
Inflammatory Cytokine ◽  
Serum Levels ◽  
Spontaneous Circulation ◽  
Neutrophil Activation ◽  
Return Of Spontaneous Circulation ◽  
Small Subgroup ◽  
Hospital Cardiac Arrest

IntroductionOnly mild therapeutic hypothermia (MTH) is shown to improve outcome after return of spontaneous circulation, post out of hospital cardiac arrest (OHCA), though its mechanism remains unknown. We hypothesise that the benefit of MTH is mediated through modulation of the inflammatory response.MethodsDuring our prospective observational study from Aug 2008 to October 2009, 196 OHCA patients were enrolled. 173 were eligible for inclusion; 115 died in Emergency Department (ED), 38 died in intensive care unit (ICU) and 20 survived to discharge. Patients had blood sampled on arrival in the ED and at 24 h, 72 h and 5 days. A small subgroup of patients had blood sampled prehospital during the initial resuscitation phase. Serum levels of cytokines important in the regulation of inflammation (interleukin 6 (IL-6), IL-8, IL-10) were measured along with markers of neutrophil activation (elastase and CD 11b). All patients who reached the ICU had MTH induced and were maintained at 32–34° for 24 h.ResultsLevels of the pro-inflammatory cytokine IL-8 were significantly higher at 24 h after return of spontaneous circulation in patients who died in ICU, compared to those who survived to discharge (478.1 pg/ml (CI 171.1 to 831.1) cf 108.0 pg/ml (CI 44.8 to 171.1) p=0.03). Serum levels of the ‘anti’-inflammatory cytokine IL-10 were also much higher in non-survivors (CI 80.9 pg/ml (22.3 to 139.4) cf CI 10.2pg/ml (3.6 to 16.8) p=0.002). IL-10 predicted survival 24 h with an area under the Receiver Operating Characteristic of 0.91 (CI 0.77 to 1.0, p<0.001), and a sensitivity of 100%, specificity 75% at a cut off of 32 pg/ml, LR 4.0. Indicators of neutrophil activation, were markedly elevated in all patients on arrival in the ED.DiscussionOHCA is associated with massive systemic inflammation. We have shown that this begins much earlier than previously described, and that levels of both the classically pro-inflammatory and counterregulatory chemokines predict survival. Our findings are consistent with the hypothesis that MTH works, at least in part, by modulating the inflammation.

Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shuichi Hagiwara ◽  
Kiyohiro Oshima ◽  
Masato Murata ◽  
Makoto Aoki ◽  
Kei Hayashida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Statistical Significance ◽  
Coronary Arteriography ◽  
Spontaneous Circulation ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Overall Performance ◽  
The Mean ◽  
Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

scholarly journals Inter-Hospital Transfer after Return of Spontaneous Circulation Shows no Correlation with Neurological Outcomes in Cardiac Arrest Patients Undergoing Targeted Temperature Management in Cardiac Arrest Centers

2020 ◽  
Vol 9 (6) ◽  
pp. 1979
Author(s):  
Yoon Hee Choi ◽  
Dong Hoon Lee ◽  
Je Hyeok Oh ◽  
Jin Hong Min ◽  
Tae Chang Jang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Neurologic Outcomes ◽  
Hospital Transfer ◽  
St Elevation ◽  
Transferred Patients

This study evaluated whether inter-hospital transfer (IHT) after the return of spontaneous circulation (ROSC) was associated with poor neurological outcomes after 6 months in post-cardiac-arrest patients treated with targeted temperature management (TTM). We used data from the Korean Hypothermia Network prospective registry from November 2015 to December 2018. These out-of-hospital cardiac arrest (OHCA) patients had either received post-cardiac arrest syndrome (PCAS) care at the same hospital or had been transferred from another hospital after ROSC. The primary endpoint was the neurological outcome 6 months after cardiac arrest. Subgroup analyses were performed to determine differences in the time from ROSC to TTM induction according to the electrocardiography results after ROSC. We enrolled 1326 patients. There were no significant differences in neurological outcomes between the direct visit and IHT groups. In patients without ST elevation, the mean time to TTM was significantly shorter in the direct visit group than in the IHT group. IHT after achieving ROSC was not associated with neurologic outcomes after 6 months in post-OHCA patients treated with TTM, even though TTM induction was delayed in transferred patients.

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