Abstract 12120: Intracranial Pressure Increases Both During Mild Therapeutic Hypothermia and During Rewarming Period in Post Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hiromichi Naito ◽  
Eiji Isotani ◽  
Clifton W Callaway ◽  
Shingo Hagioka ◽  
Naoki Morimoto
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Therapeutic Hypothermia ◽  
Perfusion Pressure ◽  
Cerebral Performance Category ◽  
Secondary Brain Injury ◽  
Surface Cooling ◽  
Cooling Device ◽  
Performance Category

Introduction: Elevation of intracranial pressure (ICP) may induce secondary brain injury and worsen the neurological outcome. Some studies on traumatic brain injury show that rapid rewarming can result in poorer outcomes contributory due to elevation of ICP. However, little is known about ICP during therapeutic hypothermia (TH) and rewarming period in post cardiac arrest patients. Hypothesis: We tested if there is occurrence of increased ICP during mild TH and rewarming period and whether it is related to outcome in patients resuscitated after cardiac arrest. Methods: Comatose patients resuscitated from cardiac arrest, treated with TH and ICP monitored were enrolled in the study. Surface cooling device was used for TH. Patients were maintained in target core temperature of 34 °C for 24 hrs. Thereafter, the temperature was regulated to increase to normothermia (37.0 °C) at the rate of 0.25 °C/hr. ICP and cerebral perfusion pressure (CPP) were monitored during the period. Cerebral Performance Category (CPC) scale was obtained 28 days later. Results: Data of 9 patients were analyzed (8 [89 %] men, age: 62 ± 17 years, cardiac origin 3 [33 %]/non-cardiac origin: 6 [67 %], CPC 1: 2 patients; CPC 2: 1 patient; CPC 3: 1 patient; CPC 4: 2 patients; CPC 5: 3 patients). ICP was 7.7 ± 4.4 mmHg at the beginning of TH and significantly elevated to 17.4 ± 13.3 mmHg at the end of TH (p = 0.03). ICP was 23.6 ± 19.1 mmHg at the end of rewarming which was higher than the end of TH (p = 0.04). At the end of rewarming, ICP value ranged in variety from 10 mmHg (CPC 1) to 68 mmHg (CPC 5). CPP was 81.3 ± 15.6 mmHg at the beginning of TH and was 72.1 ± 22.7 mmHg (p = 0.22) at the end of rewarming. All the cases with CPP less than 40 mmHg within 48 hrs died. Conclusions: ICP is increasing both during TH of target temperature 34°C and during rewarming at speed of 0.25 °C/hr in patients after cardiac arrest. Increment of ICP seems to be greater in cases with poorer outcome. CPP decrease was not usually observed and was limited to fatal cases.

Judgments of Critical Care Nurses About Risk for Secondary Brain Injury

2010 ◽  
Vol 19 (3) ◽  
pp. 250-260 ◽  
Author(s):  
Molly McNett ◽  
Margaret Doheny ◽  
Carol A. Sedlak ◽  
Ruth Ludwick
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Oxygen Saturation ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Secondary Brain Injury ◽  
Intensive Care Unit Nurses

Background Interdisciplinary care for patients with traumatic brain injury focuses on treating the primary brain injury and limiting further brain damage from secondary injury. Intensive care unit nurses have an integral role in preventing secondary brain injury; however, little is known about factors that influence nurses’ judgments about risk for secondary brain injury. Objective To investigate which physiological and situational variables influence judgments of intensive care unit nurses about patients’ risk for secondary brain injury, management solely with nursing interventions, and management by consulting another member of the health care team. Methods A multiple segment factorial survey design was used. Vignettes reflecting the complexity of real-life scenarios were randomly generated by using different values of each independent variable. Surveys containing the vignettes were sent to nurses at 2 level I trauma centers. Multiple regression was used to determine which variables influenced judgments about secondary brain injury. Results Judgments about risk for secondary brain injury were influenced by a patient’s oxygen saturation, intracranial pressure, cerebral perfusion pressure, mechanism of injury, and primary diagnosis, as well as by nursing shift. Judgments about interventions were influenced by a patient’s oxygen saturation, intracranial pressure, and cerebral perfusion pressure and by nursing shift. The initial judgments made by nurses were the most significant variable predictive of follow-up judgments. Conclusions Nurses need standardized, evidence-based content for management of secondary brain injury in critically ill patients with traumatic brain injury.

Therapeutic hypothermia with a novel surface cooling device improves neurologic outcome after prolonged cardiac arrest in swine*

2008 ◽  
Vol 36 (3) ◽  
pp. 895-902 ◽  
Author(s):  
Andreas Janata ◽  
Wolfgang Weihs ◽  
Keywan Bayegan ◽  
Alexandra Schratter ◽  
Michael Holzer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurologic Outcome ◽  
Surface Cooling ◽  
Cooling Device

Cerebral Perfusion Pressure and Intracranial Pressure in Traumatic Brain Injury

2015 ◽  
Vol 33 (1) ◽  
pp. 111-183 ◽  
Author(s):  
Pamela H. Mitchell ◽  
Catherine Kirkness ◽  
Patricia A. Blissitt
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Nursing Care ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Secondary Brain Injury ◽  
Nursing Research ◽  
Arterial Blood

Nearly 300,000 children and adults are hospitalized annually with traumatic brain injury (TBI) and monitored for many vital signs, including intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Nurses use these monitored values to infer the risk of secondary brain injury. The purpose of this chapter is to review nursing research on the monitoring of ICP and CPP in TBI. In this context, nursing research is defined as the research conducted by nurse investigators or research about the variables ICP and CPP that pertains to the nursing care of the TBI patient, adult or child. A modified systematic review of the literature indicated that, except for sharp head rotation and prone positioning, there are no body positions or nursing activities that uniformly or nearly uniformly result in clinically relevant ICP increase or decrease. In the smaller number of studies in which CPP is also measured, there are few changes in CPP since arterial blood pressure generally increases along with ICP. Considerable individual variation occurs in controlled studies, suggesting that clinicians need to pay close attention to the cerebrodynamic responses of each patient to any care maneuver. We recommend that future research regarding nursing care and ICP/CPP in TBI patients needs to have a more integrated approach, examining comprehensive care in relation to short- and long-term outcomes and incorporating multimodality monitoring. Intervention trials of care aspects within nursing control, such as the reduction of environmental noise, early mobilization, and reduction of complications of immobility, are all sorely needed.

scholarly journals Usefulness of a surface cooling device (Arctic Sun®) for therapeutic hypothermia following cardiac arrest

2014 ◽  
Vol 63 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Takuro Shinada ◽  
Noritake Hata ◽  
Shinya Yokoyama ◽  
Nobuaki Kobayashi ◽  
Kazunori Tomita ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Surface Cooling ◽  
Cooling Device

scholarly journals Cardiac arrest caused by accidental severe hypothermia and myocardial infarction during general anesthesia

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098794
Author(s):  
Dong Ho Park ◽  
Tae Woo Kim ◽  
Mo Se Kim ◽  
Woong Han ◽  
Da Eun Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Traumatic Brain Injury ◽  
Cardiac Arrest ◽  
Brain Injury ◽  
General Anesthesia ◽  
Therapeutic Hypothermia ◽  
Neuroprotective Effect ◽  
Adverse Outcomes ◽  
Secondary Brain Injury ◽  
Severe Hypothermia

Therapeutic hypothermia is often used for traumatic brain injury because of its neuroprotective effect and decreased secondary brain injury. However, this procedure lacks clinical evidence supporting its efficacy, and adverse outcomes have been reported during general anesthesia. A 61-year-old man with a history of percutaneous coronary intervention (PCI) was admitted with traumatic brain injury. Immediately after admission, he underwent mild therapeutic hypothermia with a target temperature of 33.0°C for neuroprotection. During general anesthesia for emergency surgery because he developed a mass effect, hypothermic cardiac arrest occurred following an additional decrease in the core body temperature. Moreover, myocardial infarction caused by restenosis of the previous PCI lesion also contributed to the cardiac arrest. Although the patient recovered spontaneous circulation after an hour-long cardiopulmonary resuscitation with rewarming, he eventually died of subsequent repetitive cardiac arrests. When anesthetizing patients undergoing therapeutic hypothermia, caution is required to prevent adverse outcomes that can be caused by unintentional severe hypothermia and exacerbation of underlying heart disease.

scholarly journals Different Stratification of Physiological Factors Affecting Cerebral Perfusion Pressure in Hypoxic-Ischemic Brain Injury after Cardiac Arrest According to Visible or Non-Visible Primary Brain Injury: A Retrospective Observational Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5385
Author(s):  
Changshin Kang ◽  
Wonjoon Jeong ◽  
Jung Soo Park ◽  
Yeonho You ◽  
Jin Hong Min ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Arterial Oxygen ◽  
Secondary Brain Injury ◽  
Physiological Factors ◽  
Factors Affecting ◽  
Neurological Outcomes

We aimed to explore the stratification of physiological factors affecting cerebral perfusion pressure, including arterial oxygen tension, arterial carbon dioxide tension, mean arterial pressure, intracranial pressure (ICP), and blood-brain barrier (BBB) status, with respect to primary or secondary brain injury (PBI or SBI) after out-of-hospital cardiac arrest (OHCA). Among the retrospectively enrolled 97 comatose OHCA survivors undergoing post-cardiac arrest (PCA) care, 46 (47.4%) with already established PBI (high signal intensity (HSI) on diffusion-weighted imaging (DWI) had higher ICP (p = 0.02) and poorer BBB status (p < 0.01) than the non-HSI group. On subgroup analysis within the non-HSI group to exclude the confounding effect of already established PBI, 40 (78.4%) patients with good neurological outcomes had lower ICP at 24 h (11.0 vs. 16.0 mmHg, p < 0.01) and more stable BBB status (p = 0.17 in pairwise comparison) compared to those with poor neurological outcomes, despite the non-significant differences in other physiological factors. OHCA survivors with HSI on DWI showed significantly higher ICP and poorer BBB status at baseline before PCA care than those without HSI. Despite the negative DWI findings before PCA care, OHCA survivors have a cerebral penumbra at risk for potentially leading the poor neurological outcome from unsuppressed SBI, which may be associated with increased ICP and BBB permeability.

scholarly journals Impact of the cardiopulmonary resuscitation-related injuries on the prognosis after cardiac arrest

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Merino Argos ◽  
I Marco Clement ◽  
S.O Rosillo Rodriguez ◽  
L Martin Polo ◽  
E Arbas Redondo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
University Hospital ◽  
Temperature Management ◽  
Performance Category ◽  
Neurological Outcomes ◽  
Cardiac Care Unit ◽  
Sternal Fractures

Abstract Background Cardiopulmonary resuscitation (CPR) manoeuvres involve vigorous compressions with the proper depth and rate in order to keep sufficient perfusion to organs, especially the brain. Accordingly, high incidences of CPR-related injuries (CPR-RI) have been observed in survivors after cardiac arrest (CA). Purpose To analyse whether CPR-related injuries have an impact on the survival and neurological outcomes of comatose survivors after CA. Methods Observational prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary university hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (TTM 32–34°) from August 2006 to December 2019. CPR-RI were diagnosed by reviewing medical records and analysing image studies during hospitalization. Results A total of 498 pts were included; mean age was 62.7±14.5 years and 393 (78.9%) were men. We found a total of 145 CPR-RI in 109 (21.9%) pts: 79 rib fractures, 20 sternal fractures, 5 hepatic, 5 gastrointestinal, 3 spleen, 1 kidney, 26 lung and 6 heart injuries. Demographic characteristics and cardiovascular risk factors did not differ between the non-CPR-RI group and CPR-RI group. Also, we did not find differences in CA features (Table 1). Survival at discharge was higher in the CPR-RI group [74 (67.8%) vs 188 (48.3%); p&lt;0.001]. Moreover, Cerebral Performance Category (CPC) 1–2 within a 3-month follow-up was significantly higher in the CPR-RI group [(71 (65.1%) vs 168 (43.2%); p&lt;0.001; Figure 1]. Finally, pts who recieved blood transfusions were proportionally higher in the CPR-RI group [34 (32.1%) vs 65 (16.7%)]; p=0.004). Conclusions In our cohort, the presence of CPR-RI was associated with higher survival at discharge and better neurological outcomes during follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

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