scholarly journals Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: A randomized controlled trial 

2020 ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mild Hypothermia ◽  
Controlled Trial ◽  
Good Neurological Outcome ◽  
Surface Cooling ◽  
Local Cooling ◽  
Head Surface ◽  
Significant Difference ◽  
Hemispheric Infarction

Abstract Background: The effect of hypothermia on large hemispheric infarction (LHI) remains controversial. Our study aimed to explore the therapeutic outcomes of decompressive craniectomy (DC) combined with hypothermia on LHI.Methods: Patients were randomly divided into three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. The DC group was maintained normothermia. The DCSC group received 24-hour ice cap on the head for 7 days. While the DCEH group were given endovascular hypothermia (34°C ). Mortality and modified Rankin Scale (mRS) score at 6 months were evaluated.Results: Thirty-four patients were included in the study. Mortality of the DC, DCSC and DCEH groups at discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. However, it increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11) at 6 months, respectively (P=0.367) . Pneumonia (8 cases) was the leading cause of death after discharge. Twelve cases (35.3%) achieved good neurological outcome (mRS 0-3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p=0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p=0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; P=0.025).Conclusions: There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Clinical Trial Registration-Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered, URL: http://www.chictr.org.cn.

scholarly journals Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mild Hypothermia ◽  
Controlled Trial ◽  
Good Neurological Outcome ◽  
Surface Cooling ◽  
Local Cooling ◽  
Head Surface ◽  
Significant Difference ◽  
Hemispheric Infarction

Abstract Background The effect of hypothermia on large hemispheric infarction (LHI) remains controversial. Our study aimed to explore the therapeutic outcomes of decompressive craniectomy (DC) combined with hypothermia on LHI. Methods Patients were randomly divided into three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. The DC group was maintained normothermia. The DCSC group received 24-h ice cap on the head for 7 days. While the DCEH group were given endovascular hypothermia (34 °C). Mortality and modified Rankin Scale (mRS) score at 6 months were evaluated. Results Thirty-four patients were included in the study. Mortality of the DC, DCSC and DCEH groups at discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. However, it increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11) at 6 months, respectively (p = 0.367). Pneumonia (8 cases) was the leading cause of death after discharge. Twelve cases (35.3%) achieved good neurological outcome (mRS 0–3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p = 0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p = 0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; p = 0.025). Conclusions There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications. Trial registration Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered, URL: http://www.chictr.org.cn/showproj.aspx?proj=6854.

scholarly journals Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: A randomized controlled trial

2020 ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mortality Rates ◽  
Target Temperature ◽  
Good Neurological Outcome ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Standard Medical Treatment ◽  
Hemispheric Infarction

Abstract Background: To investigate the effects of decompressive craniectomy (DC) combined with hypothermia treatment on mortality and neurological outcomes in patients with large hemispheric infarction (LHI).Methods: Patients within 48 hours of symptom onset were randomized to the following three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. Patients in the DC group were given standard medical treatment with a normothermic target temperature. Patients in the DCSC group received standard medical treatment plus 24-hour ice cap on the head for 7 days. Patients in the DCEH group were given standard medical treatment plus endovascular hypothermia with a target temperature of 34°C. The primary end-points were mortality and modified Rankin Scale (mRS) score at 6 months.Results: There were 9 patients in the DC group, 14 patients in the DCSC group and 11 patients in the DCEH group. The mortality rates of the DC, DCSC and DCEH groups at the time of discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. At 6 months, the mortality rates in the DC, DCSC and DCEH groups increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11), respectively (P=0.367). The most common cause of death after discharge was pneumonia (8 cases). Twelve cases (35.3%) achieved good neurological outcome (mRS 0-3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p=0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome, still without significant difference (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p=0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; P=0.025).Conclusions: There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Clinical Trial Registration - Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered, URL: http://www.chictr.org.cn.

scholarly journals Decompressive Craniectomy Combined With Mild Hypothermia in Patients With Large Hemispheric Infarction: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mortality Rates ◽  
Target Temperature ◽  
Good Neurological Outcome ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Standard Medical Treatment ◽  
Hemispheric Infarction

Abstract BackgroundTo investigate the effects of decompressive craniectomy (DC) combined with hypothermia treatment on mortality and neurological outcomes in patients with large hemispheric infarction (LHI).MethodsPatients within 48 hours of symptom onset were randomized to the following three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. Patients in the DC group were given standard medical treatment with a normothermic target temperature. Patients in the DCSC group received standard medical treatment plus 24-hour ice cap on the head for 7 days. Patients in the DCEH group were given standard medical treatment plus endovascular hypothermia with a target temperature of 34 °C. The primary end-points were mortality and modified Rankin Scale (mRS) score at 6 months.ResultsThere were 9 patients in the DC group, 14 patients in the DCSC group and 11 patients in the DCEH group. The mortality rates of the DC, DCSC and DCEH groups at the time of discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. At 6 months, the mortality rates in the DC, DCSC and DCEH groups increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11), respectively (P = 0.367). The most common cause of death after discharge was pneumonia (8 cases). Twelve cases (35.3%) achieved good neurological outcome (mRS 0–3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p = 0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome, still without significant difference (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p = 0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; P = 0.025).ConclusionsThere is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Clinical Trial Registration-Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered,URL: http://www.chictr.org.cn.

scholarly journals Cranioplasty following decompressive craniectomy – Analysis of complication rates and neurological outcomes: A single center study

2019 ◽  
Vol 10 ◽  
pp. 142 ◽  
Author(s):  
Saraj Singh ◽  
Rakesh Singh ◽  
Kapil Jain ◽  
Bipin Walia
Keyword(s):  
Decompressive Craniectomy ◽  
Complication Rate ◽  
Neurological Outcome ◽  
Simple Procedure ◽  
Surgical Techniques ◽  
Bone Flap ◽  
Intracerebral Hematoma ◽  
Complication Rates ◽  
Good Neurological Outcome ◽  
Second Surgery

Background:Cranioplasty is the surgical intervention to repair cranial defects in both cosmetic and functional ways. Despite the fact that cranioplasty is a simple procedure, it is still associated with a relatively high complication rate, ranging between series from 12% to 50%.Methods:The author did a prospective cohort study of patients from August 2015 to December 2017, who had undergone decompressive craniectomy followed by cranioplasty after 6 weeks at our institution. All patients were followed up to 6 months after cranioplasty and complications were recorded both by imaging and clinically. The complications were classified as minor (subgaleal collection, seizures) who did not require the second surgery and major (hydrocephalus, bone flap infection) who required the second surgery. To find out neurological outcome, Glasgow coma score (GCS) and Glasgow outcome scale extended (GOSE) were recorded at 1 month, 3 months, and 6 months.Results:Overall complication rate in this study was 22.4% (16/72). Subgaleal collection was the most common complication (5.6%), followed by hydrocephalus (4.2%), seizure (4.2%), bone flap infection (2.8%), intracerebral hematoma (2.8%), empyema (1.4%), and subdural hematoma (SDH) (1.4%). Of these, 8.4% (n= 6/72) were major complication (hydrocephalusn= 3, bone flap infectionn= 2, and SDHn= 1) which required the second surgery. GCS and GOSE were assessed preoperatively and in postoperative period at 1 month, 3 months, and 6 months. Both mean values of GCS and GOSE showed a significant improvement at 3 and 6 months after cranioplasty.Conclusion:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications.Key Message:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications. However, complications rate can be brought down by meticulous timing of cranioplasty in a patient of well-controlled comorbidities and precise surgical techniques. However, storing bone in bone bank is not an additional factor for any postcranioplasty complications which was considered previously.

scholarly journals Therapeutic hypothermia and neurological outcome after cardiac arrest

2011 ◽  
Vol 68 (6) ◽  
pp. 495-499 ◽  
Author(s):  
Milovan Petrovic ◽  
Gordana Panic ◽  
Aleksandra Jovelic ◽  
Tibor Canji ◽  
Ilija Srdanovic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Mild Hypothermia ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Normothermic Group ◽  
The Impact

Introduction/Aim. The most important clinically relevant cause of global cerebral ischemia is cardiac arrest. Clinical studies showed a marked neuroprotective effect of mild hypothermia in resuscitation. The aim of this study was to evaluate the impact of mild hypothermia on neurological outcome and survival of the patients in coma, after cardiac arrest and return of spontaneous circulation. Methods. The prospective study was conducted on consecutive comatose patients admitted to our clinic after cardiac arrest and return of spontaneous circulation, between February 2005 and May 2009. The patients were divided into two groups: the patients treated with mild hypothermia and the patients treated conservatively. The intravascular in combination with external method of cooling or only external cooling was used during the first 24 hours, after which spontaneous rewarming started. The endpoints were survival rate and neurological outcome. The neurological outcome was observed with Cerebral Performance Category Scale (CPC). Follow-up was 30 days. Results. The study was conducted on 82 patients: 45 patients (age 57.93 ? 14.08 years, 77.8% male) were treated with hypothermia, and 37 patients (age 62.00 ? 9.60 years, 67.6% male) were treated conservatively. In the group treated with therapeutic hypothermia protocol, 21 (46.7%) patients had full neurological restitution (CPC 1), 3 (6.7%) patients had good neurologic outcome (CPC 2), 1 (2.2%) patient remained in coma and 20 (44.4%) patients finally died (CPC 5). In the normothermic group 7 (18.9%) patients had full neurological restitution (CPC 1), and 30 (81.1%) patients remained in coma and finally died (CPC 5). Between the two therapeutic groups there was statistically significant difference in frequencies of different neurologic outcome (p = 0.006), specially between the patients with CPC 1 and CPC 5 outcome (p = 0.003). In the group treated with mild hypothermia 23 (51.1%) patients survived, and in the normothermic group 30 (81.1%) patients died, while in the group of survived patients 23 (76.7%) were treated with mild hypothermia (p = 0.003). Conclusion. Mild therapeutic hypothermia applied after cardiac arrest improved neurological outcome and reduced mortality in the studied group of comatose survivors.

scholarly journals Improved Neurological Outcome With Mild Hypothermia in Surviving Patients With Massive Cerebral Hemispheric Infarction

Stroke ◽  
2016 ◽  
Vol 47 (2) ◽  
pp. 457-463 ◽  
Author(s):  
Yingying Su ◽  
Linlin Fan ◽  
Yunzhou Zhang ◽  
Yan Zhang ◽  
Hong Ye ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Mild Hypothermia ◽  
Hemispheric Infarction

scholarly journals Neurological Outcome of Chest Compression-Only Bystander CPR in Asphyxial and Non-Asphyxial Out-of-Hospital Cardiac Arrest: An Observational Study

2020 ◽  
Author(s):  
François Javaudin ◽  
Julien Raiffort ◽  
Natacha Desce ◽  
Valentine Baert ◽  
Hervé Hubert ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Adjusted Relative Risk ◽  
Good Neurological Outcome ◽  
Significant Difference ◽  
Bystander Cpr ◽  
Lower Infection ◽  
Hospital Cardiac Arrest

Abstract Background: According to guidelines and bystander skill, two different methods of cardiopulmonary resuscitation (CPR) are feasible: standard CPR (S-CPR) with mouth-to-mouth ventilations and chest compression-only CPR (CO-CPR) without rescue breathing. CO-CPR appears to be most effective for cardiac causes, but there is a lack of evidence for asphyxial causes of out-of-hospital cardiac arrest (OHCA). Thus, the aim of our study was to compare CO-CPR versus S-CPR in adult OHCA from medical etiologies and assess neurologic outcome in asphyxial and non-asphyxial causes.Methods: Using the French National OHCA Registry (RéAC), we performed a multicenter retrospective study over a five-year period (2013 to 2017). All adult-witnessed OHCA who had benefited from either S-CPR or CO-CPR by bystanders were included. Non-medical causes as well as professional rescuers as witnesses were excluded. The primary end point was 30-day neurological outcome in a weighted population for all medical causes, and then for asphyxial, non-asphyxial and cardiac causes. Results: Of the 8 619 subjects included for all medical causes, 6 742 had a non-asphyxial etiology, including 5 904 of cardiac causes, and 1 710 had an asphyxial OHCA. 8.6%; 95% CI [8.1-9.3] of subjects had a good neurological outcome (i.e. cerebral performance category of 1 or 2). Bystanders who performed S-CPR began more often immediately (89.0%; 95% CI [87.3-90.5] versus 78.2%; 95% CI [77.2-79.2]) and in younger subjects (64.1 years versus 65.7; p < 0.001). In the weighted population, subjects receiving bystander-initiated CO-CPR had an adjusted relative risk (aRR) of 1.04; 95% CI [0.79-1.38] of having a good neurological outcome at 30 days for all medical causes, 1.28; 95% CI [0.92-1.77] for asphyxial etiologies, 1.08; 95% CI [0.80-1.46] for non-asphyxial etiologies and 1.09; 95% CI [0.93-1.28] for cardiac-related OHCA.Conclusions: We observed no significant difference in neurological outcome when lay bystanders of OHCA initiated CO-CPR or S-CPR, whether the cause was asphyxial or not. CO-CPR should probably be promoted in adults because it has many advantages (easier to learn and lower infection risk).

Abstract P136: Tracheal Temperature for Monitoring Core Temperature during Mild Hypothermia in Pigs

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Danica Krizanac ◽  
Moritz Haugk ◽  
Wolfgang Weihs ◽  
Michael Holzer ◽  
Keywan Bayegan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pulmonary Artery ◽  
Temperature Measurement ◽  
Core Temperature ◽  
Tracheal Tube ◽  
Mild Hypothermia ◽  
Temperature Monitoring ◽  
Surface Cooling ◽  
Significant Difference ◽  
Mean Differences

Purpose of the stud y: Early out-of-hospital induction of mild hypothermia after cardiac arrest needs an easy to use and accurate core temperature monitoring, which might be achievable with tracheal temperature measurement. The aim of the study was to evaluate which tracheal temperature site (Ttra) reflects best pulmonary artery temperature (Tpa) during the induction of mild hypothermia. Methods: Eight pigs (29 –38 kg) were anesthetized and intubated with a specially designed endotracheal tube with three temperature probes: Ttra1 was attached to the wall of the tube, 1 cm proximal to the cuff-balloon, without contact to the mucosa; Ttra2 and Ttra3 were placed on the cuff-balloon with tight contact to the mucosa, whereas Ttra3 was covered by a plastic tube to protect the mucosa. Core temperature was measured with a pulmonary artery catheter (Tpa). Pigs were cooled with a new surface cooling device (Emcoolspad®, Vienna, Austria). Data are presented as mean (±SD), and mean differences (95% CI). Results: Emcoolspad® decreased Tpa from 38.5°C to 33°C in 31±10 min, which translates into a cooling rate of 11.9±3.8°C/h. Overall mean differences of tracheal temperatures to pulmonary artery temperature (Tpa) are shown in table 1 . Ttra 1 showed the least difference to Tpa, followed by Ttra 2 and Ttra 3. There was a significant difference in temperature differences (Ttra-Tpa) related to temperature measurement site on the tracheal tube (p<0.007). Conclusions: The temperature probe proximal of the cuff (Ttra 1) reflects best pulmonary artery temperature. It seems to be an accurate surrogate for core temperature during the induction of mild hypothermia. The industry is asked to provide a tracheal tube with a temperature sensor for simple temperature monitoring during fast cooling to facilitate the implementation of mild hypothermia after cardiac arrest in the out-of-hospital setting.

Abstract 160: Interval From Collapse to Reaching Target Temperature Had No Impact for the Neurological Outcome in Post Cardiac Arrest Victims, Retrospective Cohort Study of J-Pulse-Hypo Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tadashi Kaneko ◽  
Shunji Kasaoka ◽  
Yoshio Tahara ◽  
Ken Nagao ◽  
Naohiro Yonemoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Controlled Study ◽  
Target Temperature ◽  
Surface Cooling ◽  
Significant Difference ◽  
D 63 ◽  
Favorable Neurological Outcome ◽  
Post Cardiac Arrest Syndrome ◽  
Study Database

Introduction: Currently, the ICEREA study, randomized controlled study of comparison between intravascular and surface cooling for post cardiac arrest syndrome (PCAS), did not show significant advantage of intravascular cooling to improve neurological outcome (Odds ratio 1.41, P = 0.07) (Circulation 2015;132:182-93). However, the study showed that intravascular cooling group showed significant shorter interval to reach 34 0 C (5.5 hr v.s. 8.5 hr, P<0.001). These results indicated the possibility of shorter cooling interval could improve neurological outcome of PCAS cases. Hypothesis: Shorter cooling interval could improve neurological outcome in PCAS cases. Methods: Inclusion criteria was witnessed, 34 0 C of target temperature (TT), and within 12 hr interval from collapse to reach TT. Three hundred were selected as eligible cases for this study from participants with J-PULSE-Hypo study database. The 300 cases were divided into 4 groups (A: interval from collapse to reach TT within 180 min, B: 181-360 min, C: 363-540 min, D: 541-720 min), and compared the favorable neurological outcome (CPC 1-2) by univariate and multivariate analysis. Results: Groups were A: 88 cases, B: 114 cases, C: 74 cases, and D: 24 cases. 477 participants were analyzed. The comparison of each groups for favorable neurological outcome, were not significant difference (A: 46%, B: 62%, C: 61%, and D: 63%, univariate: P = 0.109, multivariate: P = 0.812). Conclusions: Shorter cooling interval could not show advantage to improve neurological outcome in PCAS cases.

Abstract 43: Could Serum Lactate Level Predict Neurological Outcome in Patients Undergoing Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Francesca Verginella ◽  
Alice Scamperle ◽  
Perla Rossini ◽  
Michele Zuliani ◽  
Vincenzo Campanile ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Mean Value ◽  
Serum Lactate ◽  
Current Evidence ◽  
P Value ◽  
Good Neurological Outcome ◽  
Surface Cooling ◽  
Lower Serum

Until November 2013 and the printing of TTM trial, TH was a standard of treatment in OHCA. In Italy 55.000 events of CA occur every year. Early Prognostication in neurological outcome is still difficult and controversial. We decided to investigate the influence of lactacidemia at the time of start(T0) TH and after 24 hours(T24) on neurological outcome at 6 months. After the ischemic injury, microcirculation is dysfunctional. Lactacidemia explains how the microcirculation is going to restore itself 1,2 . Methods: We did a retrospective analysis of 88 patients admitted to several Italian ICUs. Patients underwent TH trough endovascular or surface cooling. We tested lactate in mmol/L at ICU admission and after 24 hours. Neurological outcome was measured using the Pittsburgh Cerebral Performance Category Scale (CPC) by phone-interview. We analysed the data using the ROC curve. Results: The mean value of Lactate at T0 was 5,7 mmol/L and and at T24 was 3,6 mmol/L. 47 patients had a good neurological outcome (CPC score of 1-2). 41 patients had a bad neurological outcome (CPC score 3-5). Discussion and Conclusion: At T0 the AUC is 0,69, P value is 0,001. At T24 the AUC is 0,56, P value is 0,288. Lower serum lactate at T0 is weakly associated with CPC 1-2 at 6 months. On the contrary there is no correlation between lower serum lactate at T24 and good neurological outcome. This conclusion is in contrast with current evidence based in literature 3 . Despite Lactacidemia being a sign of microcirculatory damage, our study explains that Lactate at T24 can not be used to predict the neurological outcome. More studies are needed to explain if Lactates Level could be a strong prognostication index. 1 “Post-cardiac arrest syndrome” Nolan et al. Resuscitation 2008;79 2 “Microcirculation during CA and resuscitation” Fries M, et al. Crit Care Med 2006;34 3 “Association of serum lactate and survival outcomes in patients undergoing TH after CA” Starodub et al; Resuscitation 2013;84

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