scholarly journals Cardiac arrest outcomes after targeted temperature management with an esophageal cooling device

2019 ◽  
Author(s):  
Cedar Morrow Anderson ◽  
Rick Fisher ◽  
Donald Berry ◽  
J Brad Diestelhorst ◽  
Marvin Wayne
Keyword(s):  
Cardiac Arrest ◽  
Median Time ◽  
Medical Center ◽  
Cost Effective ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Entire Cohort ◽  
Icu Discharge ◽  
Core Cooling

ABSTRACTObjectiveTo assess the efficacy of an esophageal device to provide TTM (Target Temperature Management) post Cardiac ArrestDesignA chart review of all patients treated with ETTM, following cardiac arrest. Initial patient temperature, time to target, supplemental methods (water blankets, head wraps, or ice packs), and patient survival were extracted for analysis.SettingCommunity Medical Center Intensive Care UnitPatientsAll patients receiving TTM via an esophageal device post Cardiac Arrest from August 2016 to November 2018InterventionsTTM both cooling and warming via an esophageal deviceMeasurements and ResultsA total of 54 patients were treated from August 2016 to November 2018; 30 received ETM only, 22 received supplemental cooling, and 2 had treatment discontinued prior to reaching target due to recovery. Target temperatures ranged from 32 to 36 degrees. The median time to target temperature for the entire cohort was 219 minutes (IQR 81-415). For the cohorts without, and with, supplemental cooling modalities, the median time to attain target temperature was 128 minutes (IQR 71-334), and 285 minutes (IQR 204-660), respectively. Survival to ICU discharge was 51.9% for the entire cohort.ConclusionsETM attains target temperature at a rate consistent with current guidelines and with similar performance to alternative modalities. This may provide a more cost-effective and approachable core cooling option to community hospitals that only use water blankets or other surface methods.

Abstract 107: Cardiac Arrest Outcomes After Target Temperature Management With an Esophageal Cooling Device

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Marvin A Wayne ◽  
Cedar Anderson ◽  
Rick Fisher ◽  
Donald Berry ◽  
J.Brad Diestelhorst
Keyword(s):  
Cardiac Arrest ◽  
Core Temperature ◽  
Temperature Control ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Entire Cohort ◽  
New Device ◽  
Icu Discharge ◽  
Intravascular Catheters

Introduction: Optimal patient care after cardiac arrest includes targeted temperature management (TTM). Methods typically utilized for patient temperature control, including ice-packs, servo-controlled surface pads, and intravascular catheters. A new device placed in the esophagus that cools from the patient’s core may offer advantages over other methods. It avoids risks from intravascular catheters, reduces shivering from surface contact, and allows core temperature control to be rapidly performed, after placement, by nursing staff. Hypothesis: Using a nurse driven protocol we sought to quantify patient outcomes, after TTM, using an esophageal device, in our mixed-population intensive care unit. Methods: We reviewed the charts of all patients treated with esophageal TTM as part of our standard post-arrest bundle at our advanced community medical center. We recorded patient age, gender, target temperature, TTM initiation time, the time goal temperature was attained, and patient survival. Results: A total of 54 patients were treated with esophageal TTM over the study period, from August 2016 to November 2018. Of these 2 recovered and had treatment discontinued prior to reaching target, leaving 52 for analysis (19 female, 33 male, age 18-79, median age 62.5). Nurses placed all ETM devices, and target temperatures varied by clinician preference, from 32°C to 36°C. Survival to ICU discharge was 51.9% for the entire cohort, with male survival (61%) greater than female (37%), p=0.10; however, Cfor the entire cohort was 219 minutes (IQR 81-415). Survivors exhibited longer times to achieve goal temperature (median 180 minutes in non-survivors vs. 255 minutes in survivors). Conclusions: Esophageal TTM offers a nurse-driven approach to obtain rapid core temperature management, with good outcomes in our patient population. As seen elsewhere, surviving patients require longer times to reach target temperature.

Abstract 23: The Usefulness of Neuron-Specific Enolase in Cerebrospinal Fluid to Predict Neurological Prognosis in Cardiac Arrest Survivors Who Underwent Target Temperature Management: A Prospective Observational Study

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jung Soo Park
Keyword(s):  
Cerebrospinal Fluid ◽  
Cardiac Arrest ◽  
Observational Study ◽  
Neurological Outcome ◽  
Prospective Observational Study ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Outcome Group

Aim: We aimed to investigate the prognostic performance between serum NSE and cerebrospinal fluid (CSF) NSE for 6-month neurologic outcome in OHCA survivors underwent target temperature management (TTM). Hypothesis: We hypothesized that the NSE levels measured in the CSF would affect the change, earlier and more sensitively than serum, according to severity of hypoxic brain damage. Methods: This single-centre prospective observational study included out-of-hospital cardiac arrest (OHCA) patients underwent TTM. NSE levels were assessed in blood and CSF samples obtained immediately (Day 0), and 24 h (Day 1), 48 h (Day 2), and 72 h (Day 3) after return of spontaneous circulation (ROSC). The primary outcome was the 6-month neurological outcome. Results: We enrolled 34 patients (males, 24; 70.6%), 16 (47.1%) had a poor neurologic outcome. CSF NSE and serum NSE values were significantly higher in the poor outcome group compared to the good outcome group at each time point, except for serum Day 0. CSF NSE and serum NSE had area under curve (AUC) of 0.819-0.972 and 0.648-0.920, respectively. CSF NSE prognostic performances were significant higher than serum NSE at Day 1 and showed excellent AUC values (0.969; 95% Confidential Interval [CI] 0.844-0.999) and high sensitivity (93.8%; 95% CI 69.8-99.8) at 100% specificity. Conclusion: We found CSF NSE values were highly predictive and sensitive markers of 6-month poor neurological outcome in OHCA survivors treated with TTM at Day 1 after ROSC. Thus, CSF NSE level at day 1 after ROSC can be a useful early prognosticator in OHCA survivors.

Usefulness of the Degree of Blood–brain Barrier Disruption to Predict Neurological Prognosis in Cardiac Arrest Survivors who Wnderwent Target Temperature Management: A Retrospective Study

2020 ◽  
Author(s):  
Ga Ram Jeon ◽  
Hong Joon Ahn ◽  
Jung Soo Park ◽  
Insool Yoo ◽  
Yeonho You ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Brain Barrier ◽  
Neurological Outcome ◽  
Scoring System ◽  
Brain Barrier ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome

Abstract Background: This study aimed to compare the day-specific association of blood–brain barrier (BBB) disruption with neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with target temperature management (TTM).Methods: This retrospective single-center study included 68 OHCA survivors, who underwent TTM between April 2018 and December 2019. The albumin quotient (QA) was calculated as [albuminCSF] / [albuminserum] immediately (day 1), and at 24 h (day 2), 48 h (day 3), and 72 h (day 4) after return of spontaneous circulation (ROSC). The degree of BBB disruption was weighted using the following scoring system: 0.07 ≥ QA (normal), 0.01 ≥ QA > 0.007 (mild), 0.02 ≥ QA > 0.01 (moderate), and QA > 0.02 (severe). This system gave it 0 (normal), 1 (mild), 4 (moderate), and 9 (severe) points. Poor neurological outcome was determined at six months after ROSC and was defined as cerebral performance categories 3–5.Results: We enrolled 68 patients (males, 48; 71%); 37 (54%) of them had a poor neurological outcome. The distributions of this outcome at six months in patients with moderate and severe BBB disruption versus the other groups were 19/22 (80%) vs. 18/46 (50%) on day 1, 31/37 (79%) vs. 6/31 (32%) on day 2, 32/37 (81%) vs. 5/31 (30%) on day 3, and 32/39 (85%) vs. 5/29 (30%) on day 4 (P < 0.001). Using ROC analyses, the optimal cutoff values of QA levels for prediction of neurological outcomes were determined as: day 1, > 0.009 (sensitivity 56.8%, specificity 87.1%); day 2, > 0.012 (sensitivity 81.1%, specificity 87.1%); day 3, > 0.013 (sensitivity 83.8%, specificity 87.1%); day 4, > 0.013 (sensitivity 86.5%, specificity 87.1%); sum of all time points, > 0.039 (sensitivity 89.5%, specificity 79.4%); and scoring system, > 9 (sensitivity 91.9%, specificity 87.1%). Conclusions: Our results suggested that QA is a useful tool for predicting neurological outcomes in OHCA survivors treated with TTM. However, the prediction of poor neurological outcome using QA showed low sensitivity at 100% specificity. Thus, it could be used as part of a multimodal approach than as a single prognostic prediction tool.

286: EFFECT OF TARGET TEMPERATURE MANAGEMENT IN THE ICU AFTER CARDIAC ARREST STRATIFIED BY RSO2

2018 ◽  
Vol 46 (1) ◽  
pp. 125-125
Author(s):  
Yuka Nakatani ◽  
Takeo Nakayama ◽  
Kei Nishiyama ◽  
Yoshimitsu Takahashi
Keyword(s):  
Cardiac Arrest ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature

Age‐associated outcomes after survived out‐of‐hospital cardiac arrest and subsequent target temperature management

2019 ◽  
Vol 63 (8) ◽  
pp. 1079-1088
Author(s):  
Toni Pätz ◽  
Katharina Stelzig ◽  
Rüdiger Pfeifer ◽  
Undine Pittl ◽  
Holger Thiele ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Hospital Cardiac Arrest ◽  
Subsequent Target
Sign in / Sign up

Export Citation Format

Share Document