Assessment of Adverse Events and Predictors of Neurological Recovery After Therapeutic Hypothermia

Abstract

Adverse events of therapeutic hypothermia were numerous and frequent, necessitating monitoring. Neurological recovery is primarily driven by the type of arrest, the rapidity of ROSC, the time needed to provide and achieve therapeutic hypothermia, the development of seizures or infection, and the use of insulin or epinephrine.

Therapeutic hypothermia in ST elevation myocardial infarction: a systematic review and meta-analysis of randomised control trials

“…Despite the observed benefits of TH in out-of-hospital cardiac arrest in earlier trials,13 20 the physiological changes in the circulatory and metabolic systems caused by hypothermia can cause harm 21. Therapeutic cooling to core temperatures of 32–34°C results in shivering, which can be uncomfortable for awake, non-sedated patients and increases systemic oxygen consumption which in turn can perpetuate the cycle of ischaemia 22.…”

Adverse events associated with poor neurological outcome during targeted temperature management and advanced critical care after out-of-hospital cardiac arrest

“…Although AEs commonly occur during TTM and the advanced critical care period, the incidence of most AEs is not significantly different between induced hypothermia and normothermia treatment [ 16 , 17 ]. Although some investigators have reported an association between AEs recorded during critical care and mortality, few studies have investigated the relationship between AEs and neurological outcomes in patients with return of spontaneous circulation (ROSC) after OHCA [ 18 – 20 ]. Furthermore, most previous studies have been performed in Western countries, which have relatively high bystander cardiopulmonary resuscitation (CPR) rates and well-established EMS systems and where the withdrawal of life-sustaining treatment (WLST) is permitted according to the legislation.…”

Untoward Effects in the Practice of Therapeutic Hypothermia: A Literature Update

“…Although many respond to standard measures, some may end up with important morbidity and mortality. MacLaren et al compared the incidences of adverse events and predictors of good versus poor neurological recovery after TH in a review of medical records of 91 patients who received TH for ≥ 6 hours [11]. They reported that common adverse events were hypoglycemia (99%),shivering (84.6%), bradycardia (58.2%), electrolyte abnormalities (up to 91.2%), acute kidney injury (52.8%), infection(48.4%), and coagulopathy (40.7%).…”

“…Electrolyte disorders are common in TH, especially in the inductionphase. Electrolyte abnormalities such as hypokalemia, hypomagnesemia, hypophosphatemia, hypo-and hyperglycemia have been described during TH [11,[53][54][55][56]. TH typically causes a decrease in almost all electrolyte except sodium: magnesium, potassium, phosphate, and calcium which can be translated into many clinical conditions [49,57,58].…”