scholarly journals Cerebral autoregulation in anoxic brain injury patients treated with targeted temperature management

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ilaria Alice Crippa ◽  
Jean-Louis Vincent ◽  
Federica Zama Cavicchi ◽  
Selene Pozzebon ◽  
Filippo Annoni ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Body Temperature ◽  
Hospital Discharge ◽  
Core Body Temperature ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Anoxic Brain Injury ◽  
Shockable Rhythm ◽  
Core Body

Abstract Background Little is known about the prevalence of altered CAR in anoxic brain injury and the association with patients’ outcome. We aimed at investigating CAR in cardiac arrest survivors treated by targeted temperature management and its association to outcome. Methods Retrospective analysis of prospectively collected data. Inclusion criteria: adult cardiac arrest survivors treated by targeted temperature management (TTM). Exclusion criteria: trauma; sepsis, intoxication; acute intra-cranial disease; history of supra-aortic vascular disease; severe hemodynamic instability; cardiac output mechanical support; arterial carbon dioxide partial pressure (PaCO2) > 60 mmHg; arrhythmias; lack of acoustic window. Middle cerebral artery flow velocitiy (FV) was assessed by transcranial Doppler (TCD) once during hypothermia (HT) and once during normothermia (NT). FV and blood pressure (BP) were recorded simultaneously and Mxa calculated (MATLAB). Mxa is the Pearson correlation coefficient between FV and BP. Mxa > 0.3 defined altered CAR. Survival was assessed at hospital discharge. Cerebral Performance Category (CPC) 3–5 assessed 3 months after CA defined unfavorable neurological outcome (UO). Results We included 50 patients (Jan 2015–Dec 2018). All patients had out-of-hospital cardiac arrest, 24 (48%) had initial shockable rhythm. Time to return of spontaneous circulation was 20 [10–35] min. HT (core body temperature 33.7 [33.2–34] °C) lasted for 24 [23–28] h, followed by rewarming and NT (core body temperature: 36.9 [36.6–37.4] °C). Thirty-one (62%) patients did not survive at hospital discharge and 36 (72%) had UO. Mxa was lower during HT than during NT (0.33 [0.11–0.58] vs. 0.58 [0.30–0.83]; p = 0.03). During HT, Mxa did not differ between outcome groups. During NT, Mxa was higher in patients with UO than others (0.63 [0.43–0.83] vs. 0.31 [− 0.01–0.67]; p = 0.03). Mxa differed among CPC values at NT (p = 0.03). Specifically, CPC 2 group had lower Mxa than CPC 3 and 5 groups. At multivariate analysis, initial non-shockable rhythm, high Mxa during NT and highly malignant electroencephalography pattern (HMp) were associated with in-hospital mortality; high Mxa during NT and HMp were associated with UO. Conclusions CAR is frequently altered in cardiac arrest survivors treated by TTM. Altered CAR during normothermia was independently associated with poor outcome.

scholarly journals Non-invasive Monitoring of Core Body Temperature for Targeted Temperature Management in Post-Cardiac Arrest Care

2021 ◽  
Author(s):  
Kyle Fiorini ◽  
Tanya Tamasi ◽  
Justin Dorie ◽  
Ahmed F. Hegazy ◽  
Ting-Yim Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Body Temperature ◽  
Core Body Temperature ◽  
Pearson Correlation ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Invasive Monitoring ◽  
Limits Of Agreement ◽  
Non Invasive ◽  
Core Body

Abstract BackgroundAccurate monitoring of core body temperature is integral to targeted temperature management (TTM) following cardiac arrest. However, there are no reliable non-invasive methods for monitoring temperature during TTM. We compared the accuracy and precision of a novel non-invasive Zero-Heat Flux Thermometer (SpotOnä) to a standard invasive esophageal probe in a cohort of patients undergoing TTM post cardiac arrest. MethodsWe prospectively enrolled 20 patients undergoing post-cardiac arrest care in the intensive care units at the London Health Sciences Centre in London, Canada. A SpotOnä probe was applied on each patient’s forehead, while an esophageal temperature probe was inserted, and both temperature readings were recorded at 1-minute intervals for the duration of TTM. We compared the SpotOnä and esophageal monitors using Bland-Altman analysis and Pearson correlation, with accuracy set as a primary outcome. Secondary outcomes included precision and correlation. Bias exceeding 0.1°C and limits of agreement exceeding 0.5°C were considered clinically important.ResultsSixteen (80%) of patients had complete data used in the final analysis. The median (interquartile range) duration of recording was 38 (12-56) hours. Compared to the esophageal probe, SpotOnä had a bias of 0.05 ± 0.35ºC and 95% limits of agreement of -0.64 to 0.74 ºC. Pearson correlation coefficient was 0.98 (95% confidence interval 0.9796-0.9805), with a two-tailed p-value of <0.0001. ConclusionThe SpotOnä is an accurate method that may enable non-invasive monitoring of core body temperature during TTM, although its precision is slightly worse than the pre-defined 0.5°C when compared to invasive esophageal probe.

scholarly journals Trends, Predictors and Outcomes After Utilization of Targeted Temperature Management in Cardiac Arrest Patients With Anoxic Brain Injury

2020 ◽  
Vol 360 (4) ◽  
pp. 363-371
Author(s):  
Muhammad Zia Khan ◽  
Muhammad U. Khan ◽  
Kinjan Patel ◽  
Safi U. Khan ◽  
Shahul Valavoor ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Anoxic Brain Injury

Effects of Propofol on Hemodynamic Profile in Adults Receiving Targeted Temperature Management

2021 ◽  
pp. 001857872110323
Author(s):  
W. Anthony Hawkins ◽  
Jennifer Y. Kim ◽  
Susan E. Smith ◽  
Andrea Sikora Newsome ◽  
Ronald G. Hall
Keyword(s):  
Cardiac Arrest ◽  
Body Temperature ◽  
Multivariate Regression ◽  
Primary Outcome ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Hemodynamic Changes ◽  
Failure Assessment ◽  
Hemodynamic Profile ◽  
Median Change

Background: Propofol is a key component for the management of sedation and shivering during targeted temperature management (TTM) following cardiac arrest. The cardiac depressant effects of propofol have not been described during TTM and may be especially relevant given the stress to the myocardium following cardiac arrest. The purpose of this study is to describe hemodynamic changes associated with propofol administration during TTM. Methods: This single center, retrospective cohort study evaluated adult patients who received a propofol infusion for at least 30 minutes during TTM. The primary outcome was the change in cardiovascular Sequential Organ Failure Assessment (cvSOFA) score 30 minutes after propofol initiation. Secondary outcomes included change in systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), and vasopressor requirements (VR) expressed as norepinephrine equivalents at 30, 60, 120, 180, and 240 minutes after propofol initiation. A multivariate regression was performed to assess the influence of propofol and body temperature on MAP, while controlling for vasopressor dose and cardiac arrest hospital prognosis (CAHP) score. Results: The cohort included 40 patients with a median CAHP score of 197. The goal temperature of 33°C was achieved for all patients. The median cvSOFA score was 1 at baseline and 0.5 at 30 minutes, with a non-significant change after propofol initiation ( P = .96). SBP and MAP reductions were the greatest at 60 minutes (17 and 8 mmHg; P < .05 for both). The median change in HR at 120 minutes was −9 beats/minute from baseline. This reduction was sustained through 240 minutes ( P < .05). No change in VR were seen at any time point. In multivariate regression, body temperature was the only characteristic independently associated with changes in MAP (coefficient 4.95, 95% CI 1.6-8.3). Conclusion: Administration of propofol during TTM did not affect cvSOFA score. The reductions in SBP, MAP, and HR did not have a corresponding change in vasopressor requirements and are likely not clinically meaningful. Propofol appears to be a safe choice for sedation in patients receiving targeted temperature management after cardiac arrest.

scholarly journals Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1389
Author(s):  
Wojciech Wieczorek ◽  
Jarosław Meyer-Szary ◽  
Milosz J. Jaguszewski ◽  
Krzysztof J. Filipiak ◽  
Maciej Cyran ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
One Year

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.

Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ian R Drennan ◽  
Steve Lin ◽  
Kevin E Thorpe ◽  
Jason E Buick ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Injury ◽  
Good Neurologic Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

scholarly journals Malignant EEG patterns in cardiac arrest patients treated with targeted temperature management who survive to hospital discharge

Resuscitation ◽  
2015 ◽  
Vol 90 ◽  
pp. 127-132 ◽  
Author(s):  
Edilberto Amorim ◽  
Jon C. Rittenberger ◽  
Maria E. Baldwin ◽  
Clifton W. Callaway ◽  
Alexandra Popescu
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Targeted Temperature Management ◽  
Temperature Management
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