A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors*

Tømte, Øystein; Drægni, Tomas; Mangschau, Arild; Jacobsen, Dag; Auestad, Bjørn; Sunde, Kjetil

doi:10.1097/ccm.0b013e318206b80f

Cited by 150 publications

(96 citation statements)

References 33 publications

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“…Recently, it has been reported that there are no differences in temperature management between automatic surface and core cooling devices. 17 Another factor that may have had an impact on the better results in patients assigned to 32°C was that this group of patients remained cooled for a longer period of time than those assigned to 34°C. Although the duration at target temperature was similar in both groups, patients assigned to 32°C required more time to reach the target temperature, as well as a longer rewarming time.…”

Section: Lopez-de-sa Et Al Two Hypothermia Levels Post Cardiac Arrestmentioning

confidence: 99%

Hypothermia in Comatose Survivors From Out-of-Hospital Cardiac Arrest

et al. 2012

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Background— It is recommended that comatose survivors of out-of-hospital cardiac arrest should be cooled to 32° to 34°C for 12 to 24 hours. However, the optimal level of cooling is unknown. The aim of this pilot study was to obtain initial data on the effect of different levels of hypothermia. We hypothesized that deeper temperatures will be associated with better survival and neurological outcome. Methods and Results— Patients were eligible if they had a witnessed out-of-hospital cardiac arrest from March 2008 to August 2011. Target temperature was randomly assigned to 32°C or 34°C. Enrollment was stratified on the basis of the initial rhythm as shockable or asystole. The target temperature was maintained during 24 hours followed by 12 to 24 hours of controlled rewarming. The primary outcome was survival free from severe dependence (Barthel Index score ≥60 points) at 6 months. Thirty-six patients were enrolled in the trial (26 shockable rhythm, 10 asystole), with 18 assigned to 34°C and 18 to 32°C. Eight of 18 patients in the 32°C group (44.4%) met the primary end point compared with 2 of 18 in the 34°C group (11.1%) (log-rank P =0.12). All patients whose initial rhythm was asystole died before 6 months in both groups. Eight of 13 patients with initial shockable rhythm assigned to 32°C (61.5%) were alive free from severe dependence at 6 months compared with 2 of 13 (15.4%) assigned to 34°C (log-rank P =0.029). The incidence of complications was similar in both groups except for the incidence of clinical seizures, which was lower (1 versus 11; P =0.0002) in patients assigned to 32°C compared with 34°C. On the contrary, there was a trend toward a higher incidence of bradycardia (7 versus 2; P =0.054) in patients assigned to 32°C. Although potassium levels decreased to a greater extent in patients assigned to 32°C, the incidence of hypokalemia was similar in both groups. Conclusions— The findings of this pilot trial suggest that a lower cooling level may be associated with a better outcome in patients surviving out-of-hospital cardiac arrest secondary to a shockable rhythm. The benefits observed here merit further investigation in a larger trial in out-of-hospital cardiac arrest patients with different presenting rhythms. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01155622.

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Section: Lopez-de-sa Et Al Two Hypothermia Levels Post Cardiac Arrestmentioning

confidence: 99%

Hypothermia in Comatose Survivors From Out-of-Hospital Cardiac Arrest

et al. 2012

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“…Although firm answers are missing, some provocative findings are reported. In a head-tohead, single center, observational comparison of 167 patient receiving either the CoolGard (Zoll Circulation, Chelmsford, Massachusetts) or Arctic Sun (Medivance, Louisville, Colorado) systems, no significant differences were found in the rate of cooling, ICU stay, duration of mechanical ventilation, survival to discharge, survival at 6-12 mo, of neurologic outcomes [222] . Of note, more hypomagnesemia was observed in the endovascular group.…”

Section: Logistics Of Deliverymentioning

confidence: 99%

Use of hypothermia in the intensive care unit

Corry¹

2012

WJCCM

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Used for over 3600 years, hypothermia, or targeted temperature management (TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited. Despite ample experimental data, clinical evidence for stroke, refractory status epilepticus, hepatic encephalopathy, and intensive care unit is only at the safety and proof-of-concept stage. This review explores the deleterious nature of fever, the theoretical role of TTM in the critically ill, and summarizes the clinical evidence for TTM in adults.

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“…Head-to-head comparisons of surface and endovascular cooling devices after cardiac arrest have revealed similar cooling efficacy and numbers of adverse effects, except that the surface group experienced more hyperglycemia, whereas the endovascular group experienced more hypomagnesemia [87]. Although it has been proposed that catheter cooling may result in less shivering [75], this study did not show any difference in the rate of shivering between the 2 methods [87].…”

Section: Intravascular Cooling Cathetersmentioning

confidence: 50%

“…Although it has been proposed that catheter cooling may result in less shivering [75], this study did not show any difference in the rate of shivering between the 2 methods [87]. The study was not sufficiently powered to find a difference in survival or neurological outcome.…”

Section: Intravascular Cooling Cathetersmentioning

confidence: 56%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

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A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors*

Abstract: In this study, surface and core cooling of out-of-hospital cardiac arrest patients following the same established postresuscitation treatment protocol resulted in similar survival to hospital discharge and comparable neurologic function at follow-up.

Cited by 150 publications

References 33 publications

Hypothermia in Comatose Survivors From Out-of-Hospital Cardiac Arrest

Hypothermia in Comatose Survivors From Out-of-Hospital Cardiac Arrest

Use of hypothermia in the intensive care unit

Therapeutic Hypothermia for Acute Neurological Injuries

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