scholarly journals Mild therapeutic hypothermia shortens intensive care unit stay of survivors after out-of-hospital cardiac arrest compared to historical controls

Critical Care ◽  
2008 ◽  
Vol 12 (3) ◽  
pp. R78 ◽  
Author(s):  
Christian Storm ◽  
Ingo Steffen ◽  
Joerg C Schefold ◽  
Anne Krueger ◽  
Michael Oppert ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Therapeutic Hypothermia ◽  
Mild Therapeutic Hypothermia ◽  
Hospital Cardiac Arrest ◽  
Historical Controls

scholarly journals Improved Survival with Therapeutic Hypothermia after Cardiac Arrest with Cold Saline and Surfacing Cooling: Keep It Simple

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Cristina Granja ◽  
Pedro Ferreira ◽  
Orquídea Ribeiro ◽  
João Pina
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Hospital Mortality ◽  
General Hospital ◽  
Therapeutic Hypothermia ◽  
Mild Therapeutic Hypothermia ◽  
Saline Infusion ◽  
Surface Cooling ◽  
Cold Saline

Aim. To evaluate whether the introduction of a therapeutic hypothermia (TH) protocol consisting of cold saline infusion and surface cooling would be effective in targeting mild therapeutic hypothermia (32–34∘C). Additionally, to evaluate if TH would improve survival after cardiac arrest.Design. Before-after design.Setting. General Intensive Care Unit (ICU) at an urban general hospital with 470 beds.Patients and Methods. Patients admitted in the ICU after cardiac arrest between 2004 and 2009 were included. Effectiveness of the TH protocol to achieve the targeted temperature was evaluated. Hospital mortality was compared before (October 2004–March 2006) and after (April 2006–September 2009) the protocol implementation.Results. Hundred and thirty patients were included, 75 patients were not submitted to TH (before TH group), and 55 were submitted to TH (TH group). There were no significant differences concerning baseline, ICU, and cardiac arrest characteristics between both groups. There was a significant reduction in hospital mortality from 61% () in the before TH group to 40% () in the TH group.Conclusion. Our protocol consisting of cold saline infusion and surface cooling might be effective in inducing and maintaining mild therapeutic hypothermia. TH achieved with this protocol was associated with a significant reduction in hospital mortality.

Use of Neuromuscular Blockers During Therapeutic Hypothermia After Cardiac Arrest: A Nursing Protocol

2016 ◽  
Vol 36 (6) ◽  
pp. 33-40 ◽  
Author(s):  
Coraline Boulila ◽  
Samia Ben Abdallah ◽  
Aude Marincamp ◽  
Vincent Coic ◽  
Romuald Lauverjat ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Therapeutic Hypothermia ◽  
Median Duration ◽  
Intensive Care Unit Mortality ◽  
Primary Outcome Measure ◽  
Ventilator Associated Pneumonia ◽  
Neuromuscular Blockers ◽  
Hospital Cardiac Arrest

Background Neuromuscular blockers used to prevent shivering during therapeutic hypothermia in comatose patients after out-of-hospital cardiac arrest are associated with adverse events. Objective To assess the influence of a nurse-implemented protocol on use of neuromuscular blockers in patients treated with 24-hour therapeutic hypothermia after out-of-hospital cardiac arrest. Methods A before and after study was done in a 24-bed cardiac arrest center. During the before period, paralysis was maintained by continuous infusion of vecuronium during therapeutic hypothermia. During the after period, a nurse-implemented protocol was used to strictly control use of neuromuscular blockers. The primary outcome measure was duration of infusion of neuromuscular blockers; secondary end points included rates of ventilator-associated pneumonia and intensive care unit mortality. Results Among the 22 patients in the before group and the 23 patients in the after group, most were men (78%) with a median age of 66 years. Baseline characteristics were similar between the 2 groups. Median duration of sedation was 36 hours, shorter in the after group (34 hours) than in the before group (38 hours; P = .02). Median duration of infusion of neuromuscular blockers was significantly shorter in the after group (6 hours) than in the before group (33 hours; P < .001). Ventilator-associated pneumonia occurred more frequently in the before group (45%) than in the after group (13%; P = .02). Overall intensive care unit mortality rate was 58%, similar in both groups (P = .44). Conclusion Use of a nurse-implemented protocol to reduce use of neuromuscular blockers is feasible.

Safety of Mild Therapeutic Hypothermia After In-Hospital Cardiac Arrest: A Comparison With Historical Controls

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 280A
Author(s):  
Jaspreet S. Ahuja ◽  
Fukunaga Mayuko ◽  
Crescens Pellecchia ◽  
Joseph Mathew ◽  
Weiner I. Justin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Mild Therapeutic Hypothermia ◽  
Hospital Cardiac Arrest ◽  
Historical Controls

scholarly journals Post out-of-hospital cardiac arrest care in a tertiary care center in southern Thailand: From emergency department to intensive care unit

2019 ◽  
Vol 27 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Veerapong Vattanavanit ◽  
Supattra Uppanisakorn ◽  
Thanapon Nilmoje
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
American Heart Association ◽  
American Heart ◽  
Medical Intensive Care Unit ◽  
Heart Association ◽  
Temperature Management ◽  
Medical Intensive Care ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy. Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017. Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission. Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

scholarly journals Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

2019 ◽  
Vol 9 (7) ◽  
pp. 779-787 ◽  
Author(s):  
Laust Obling ◽  
Christian Hassager ◽  
Charlotte Illum ◽  
Johannes Grand ◽  
Sebastian Wiberg ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Area Under The Curve ◽  
Youden Index ◽  
Cardiac Intensive Care Unit ◽  
Infrared Pupillometry ◽  
Cardiac Intensive Care ◽  
Neurological Pupil Index ◽  
Hospital Cardiac Arrest

Background: Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint. Methods: A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities. Results: In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values. Conclusion: Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.

It does not matter to which intensive-care-unit a patient will be admitted after out of hospital cardiac arrest

Resuscitation ◽  
2010 ◽  
Vol 81 (2) ◽  
pp. S67
Author(s):  
A. Schober ◽  
A. Bojic ◽  
D. Hörburger ◽  
M. Stöckl ◽  
P. Stratil ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Patient Will ◽  
Hospital Cardiac Arrest
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