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.

Abstract 19708: Pre-Hospital Initiation of Therapeutic Hypothermia Associated With Better Survival and Neurologic Outcome in a Broad Population of Patients in North Carolina

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Meena P Rao ◽  
Matthew Dupre ◽  
Carolina Hansen ◽  
Sarah Milford-Beland ◽  
Lisa Monk ◽  
...  
Keyword(s):  
North Carolina ◽  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Hospital Survival ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) has less than 10% hospital survival. While therapeutic hypothermia resulted in a 16%-24% improvement in neurologic outcome in patients with ventricular fibrillation (VF) in prior trials, recent trials have not shown benefit of pre-hospital initiation hypothermia or of hospital cooling to 33 vs 36 degrees. Methods: We studied patients who suffered OHCA in North Carolina from 2012-2013 captured in the CARES database as part of the Heart Rescue Project. To limit selection bias, we excluded patients without return of spontaneous circulation after arrest and without intubation in the field as they may have regained consciousness. Results: 847 patients were included in the analysis of pre-hospital hypothermia. The patients that received pre-hospital hypothermia had more bystander initiated CPR (p-value < 0.45). Pre-hospital hypothermia was associated with a significant increase in survival to hospital discharge (OR 1.55, 95% CI 1.03-2.32) and neurologic outcome at discharge (OR 1.56 95% CI 1.01-2.40). When looking at arrest types, the significant association was seen after VF arrest (figure). 537 patients survived to hospital admission and included in the analysis of in-hospital hypothermia. Patients who received hospital hypothermia were younger, had more VF, more witnessed arrest and more pre-hospital hypothermia. Hypothermia showed a non-significant trend toward better survival to discharge. Conclusions: The association between pre-hospital hypothermia after VF arrest and improved survival, in light of randomized data showing no effect, may be due to confounding or to a greater likelihood of in-hospital hypothermia in this group. The trend in better outcome using in-hospital hypothermia is consistent with a benefit from temperature management. These findings suggest the need for ongoing efforts to understand the value of hypothermia in context of other efforts to improve survival from cardiac arrest.

scholarly journals Comparison of Dopamine and Norepinephrine Use for the Treatment of Hypotension in Out-Of-Hospital Cardiac Arrest Patients with Return of Spontaneous Circulation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Chao-Jui Li ◽  
Kuan-Han Wu ◽  
Chien-Chih Chen ◽  
Yat-Yin Law ◽  
Po-Chun Chuang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Study Groups ◽  
Therapeutic Agents ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
The Impact ◽  
Hospital Cardiac Arrest

In patients experiencing out-of-hospital cardiac arrest (OHCA), hypotension is common after return of spontaneous circulation (ROSC). Both dopamine and norepinephrine are recommended as inotropic therapeutic agents. This study aimed to determine the impact of the use of these two medications on hypotension. This is a multicenter retrospective cohort study. OHCA patients with ROSC were divided into three groups according to the post resuscitation inotropic agent used for treatment in the emergency department, namely, dopamine, norepinephrine, and dopamine and norepinephrine combined therapy. Thirty-day survival and favorable neurologic performance were analyzed among the three study groups. The 30-day survival and favorable neurologic performance rates in the three study groups were 12.5%, 13.0%, and 6.8% as well as 4.9%, 4.3%, and 1.2%, respectively. On controlling the potential confounding factors by logistic regression, there was no difference between dopamine and norepinephrine treatment in survival and neurologic performance (adjusted odds ratio (aOR): 1.0, 95% confidence interval (CI) 0.48–2.06; aOR: 0.8, 95% CI: 0.28–2.53). The dopamine and norepinephrine combined treatment group had worse outcome (aOR: 0.6, 95% CI: 0.35–1.18; aOR: 0.2, 95% CI: 0.05–0.89). In conclusion, there was no significant difference in post-ROSC hypotension treatment between dopamine and norepinephrine in 30-day survival and favorable neurologic performance rates.

scholarly journals The effects of cardiac arrest recognition by dispatcher on Smart Advanced Life Support

2019 ◽  
Vol 27 (5) ◽  
pp. 286-292
Author(s):  
Choung Ah Lee ◽  
Gi Woon Kim ◽  
Yu Jin Kim ◽  
Hyung Jun Moon ◽  
Yong Jin Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Epinephrine Administration ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Objectives: The purpose of this study was to analyze the effect of cardiac arrest recognition by emergency medical dispatch on the pre-hospital advanced cardiac life support and to investigate the outcome of out-of-hospital cardiac arrest. Method: This study was conducted to evaluate the out-of-hospital cardiac arrest patients over 18 years of age, excluding trauma and poisoning patients, from 1 August 2015 to 31 July 2016. We investigated whether it was a cardiac-arrest recognition at dispatch. We compared the pre-hospital return of spontaneous circulation, the rate of survival admission and discharge, good neurological outcome, and also analyzed the time of securing vein, time of first epinephrine administration, and arrival time of paramedics. Results: A total of 3695 out-of-hospital cardiac arrest patients occurred during the study period, and 1468 patients were included in the study. Resuscitation rate by caller was significantly higher in the recognition group. The arrival interval between the first and second emergency service unit was shorter as 5.1 min on average, and the connection rate of paramedics and physicians before the arrival was 32.3%, which was significantly higher than that of the unrecognized group. The mean time required to first epinephrine administration was 13.1 min, which was significantly faster in the recognition group. However, there was no statistically significant difference between the two groups in patients with good neurological outcome, and rather the rate of return of spontaneous circulation and survival discharge was significantly higher in the non-recognition group. Conclusion: Although the recognition of cardiac arrest at dispatch does not directly affect survival rate and good neurological outcome, the activation of pre-hospital advanced cardiac life support and the shortening the time of epinephrine administration can increase pre-hospital return of spontaneous circulation. Therefore, effort to increase recognition by dispatcher is needed.

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.

Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shuichi Hagiwara ◽  
Kiyohiro Oshima ◽  
Masato Murata ◽  
Makoto Aoki ◽  
Kei Hayashida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Statistical Significance ◽  
Coronary Arteriography ◽  
Spontaneous Circulation ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Overall Performance ◽  
The Mean ◽  
Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

scholarly journals Our experiences with therapeutic hypothermia

2007 ◽  
Vol 60 (9-10) ◽  
pp. 431-435 ◽  
Author(s):  
Milovan Petrovic ◽  
Ilija Srdanovic ◽  
Gordana Panic ◽  
Tibor Canji ◽  
Tihomir Miljevic
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Mild Hypothermia ◽  
Acute Myocarditis ◽  
Neuroprotective Effect ◽  
Sudden Cardiac Arrest ◽  
Neurological Recovery ◽  
Global Cerebral Ischemia ◽  
Resuscitation Guidelines

Introduction. The single most important clinically relevant cause of global cerebral ischemia is cardiac arrest. The estimated rate of sudden cardiac arrest is between 40 and 130 cases per 100.000 people per year. Almost 80% of patients initially resuscitated from cardiac arrest remain comatose for more than one hour. One year after cardiac arrest only 10-30% of these patients survive with good neurological outcome. The ability to survive anoxic no-flow states is dramatically increased with protective and preservative hypothermia. The results of clinical studies show a marked neuroprotective effect of mild hypothermia in resuscitation. Material and Methods. In our clinic, 12 patients were treated with therapeutic hypothermia. A combination of intravascular and external method of cooling was used according to the ILCOR (International Liaison Committee on Resuscitation) guidelines. The target temperature was 33oC, while the duration of cooling was 24 hours. After that, passive rewarming was allowed. All patients also received other necessary therapy. Results. Six patients (50%) had a complete neurological recovery. Two patients (16.6%) had partial neurological recovery. Four patients (33.3%) remained comatose. Five patients (41.66%) survived, while 7 (58.33%) patients died. The main cause of cardiac arrest was acute myocardial infarction (91.6%). One patient had acute myocarditis. Conclusion. Mild resuscitative hypothermia after cardiac arrest improves neurological outcome and reduces mortality in comatose survivors. .

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