Autonomic regulation during mild therapeutic hypothermia in cardiopulmonary resuscitated patients

Pfeifer, Rüdiger; Hopfe, J.; Ehrhardt, Carsten; Goernig, Matthias; Figulla, Hans R.; Voss, Andreas

doi:10.1007/s00392-011-0314-3

Cited by 8 publications

(5 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The sample size was very heterogeneous, ranging from 18 ( 11 ) to 2,178 ( 12 ) patients; the sample size was not previously calculated in any study. The most studied pathology was trauma, mainly of the head, with a total of nine studies, ( 12 - 20 ) and with the same number of studies on patients with severe sepsis and septic shock, ( 21 ) multiple dysfunction syndrome, ( 22 , 23 ) patients undergoing therapeutic hypothermia after cardiac arrest, ( 11 ) with stroke ( 24 ) and neurosurgical patients; ( 25 ) three studies focused on the general population admitted to the ICU, without discriminating the reason for admission. The conclusions of all of the studies were obtained by comparing the groups according to the outcome evaluated, namely, mortality.…”

Section: Resultsmentioning

confidence: 99%

“…Concordant results were observed in the pre-hypothermia period. ( 11 ) There was also an increase in the parasympathetic tone as measured by the square root of the mean squared differences of successive intervals (rMSSD) (34.07 ± 6.54 versus 15.51 ± 3.90; p = 0.01) in patients with severe head injury; ( 19 ) decreased power in the low frequency band (low frequency in standard units in patients with severe stroke 18.90 ± 1.36 versus 49.66 ± 2.10; p = 0.02; in the general population p < 0.05 with Scheffé analysis); ( 24 , 27 ) decreased natural logarithm of the very low frequency band (lnVLF £ 3.9 with OR 2.9; in the general population p < 0.05 with Scheffé analysis); ( 22 , 23 , 27 , 28 ) and decreased ratio of short- to long-term fractal exponents; all patients admitted to the ICU with severe sepsis or septic shock who died had a ratio of < 0.75 (p = 0.04). ( 21 ) The following were also found: decreased multiscale entropy in trauma patients (8.9 versus 16.6; p < 0.0001; 7.5 versus 11.2; p < 0.001 in patients with survival probabilities < 0.25; 7.7 versus 12.8; p < 0.01 for patients with survival probabilities of 0.25 to 0.50; 9.4 versus 15.0; p < 0.001 for patients with survival probabilities of 0.50 to 0.75; 9.9 versus 16.1; and p < 0.001 among those with survival probabilities ³ 0.75).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Autonomic nervous system monitoring in intensive care as a prognostic tool. Systematic review

Bento

Fonseca-Pinto

Póvoa

2017

Revista Brasileira De Terapia Intensiva

View full text Add to dashboard Cite

ObjectiveTo present a systematic review of the use of autonomic nervous system monitoring as a prognostic tool in intensive care units by assessing heart rate variability.MethodsLiterature review of studies published until July 2016 listed in PubMed/Medline and conducted in intensive care units, on autonomic nervous system monitoring, via analysis of heart rate variability as a prognostic tool (mortality study). The following English terms were entered in the search field: ("autonomic nervous system" OR "heart rate variability") AND ("intensive care" OR "critical care" OR "emergency care" OR "ICU") AND ("prognosis" OR "prognoses" OR "mortality").ResultsThere was an increased likelihood of death in patients who had a decrease in heart rate variability as analyzed via heart rate variance, cardiac uncoupling, heart rate volatility, integer heart rate variability, standard deviation of NN intervals, root mean square of successive differences, total power, low frequency, very low frequency, low frequency/high frequency ratio, ratio of short-term to long-term fractal exponents, Shannon entropy, multiscale entropy and approximate entropy.ConclusionIn patients admitted to intensive care units, regardless of the pathology, heart rate variability varies inversely with clinical severity and prognosis.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Autonomic nervous system monitoring in intensive care as a prognostic tool. Systematic review

Bento

Fonseca-Pinto

Póvoa

2017

Revista Brasileira De Terapia Intensiva

View full text Add to dashboard Cite

show abstract

“…The post-cardiac arrest phase is a complex combination of various processes, including myocardial dysfunction, systemic ischemia/reperfusion response and brain injury [ 3 – 5 ]. These effects lead to an activation of endogenous coagulation and anticoagulation, acidosis, and pro-inflammatory mechanisms, which can alter platelet count and function [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of enteral ticagrelor in hypothermic patients after out-of-hospital cardiac arrest

et al. 2015

View full text Add to dashboard Cite

IntroductionDelivery of crushed ticagrelor via a nasogastric tube is a widely spread off-label use in unconscious patients following out-of-hospital cardiac arrest (OHCA). Notwithstanding the importance of a potent dual antiplatelet therapy in these patients, the efficacy of crushed ticagrelor after OHCA has not been established yet.MethodsIn a prospective, single-center, observational trial, 38 consecutive MI patients after OHCA were included. 27 patients (71.1 %) underwent mild induced hypothermia. The primary outcome was platelet inhibition at 24h measured by impedance aggregometry.ResultsThere was sufficient platelet inhibition in most patients after OHCA. In all hypothermic patients, there was an adequate platelet inhibition by ticagrelor at 24 h (p < 0.001). 15 patients (39.5 %) had significant gastroesophageal reflux and one patient with significant reflux had inadequate platelet inhibition at 24 h. There were no stent thrombosis or recurrent atherothrombotic events in these patients.ConclusionAdministration of crushed ticagrelor via a nasogastric tube reliably inhibited platelet function in vitro and in vivo regardless of the presence of hypothermia in MI patients. Thus, platelet inhibition can be reliably achieved in MI patients during neuroprotective hypothermia following OHCA.

show abstract

“…Patients were sedated using midazolam and/or propofol and received adequate analgesia with fentanyl. The procedure of mild hypothermia was performed according to international standards with the Cool Gard 3000 (Zoll Ò , USA) and Hilotherm clinic (Hilotherm Ò GmbH, Germany) cooling systems [9][10][11][12]. Vasoactive or inotropic support, usually norepinephrine or dobutamine was administered if necessary.…”

Section: Standard Carementioning

confidence: 99%

The Modified Glasgow Outcome Score for the prediction of outcome in patients after cardiac arrest: a prospective clinical proof of concept study

et al. 2012

View full text Add to dashboard Cite

The Glasgow-Pittsburgh cerebral performance categories (GP-CPC) and the Glasgow Outcome Score (GOS) have been used to categorize patients according to their neurological outcome for prognostic predictors in patients after cardiac arrest (CA). We postulated that inclusion of deaths without knowing the cerebral status into the group of patients with poor outcome after CA using the GP-CPC and GOS will lead to dilution of the prognostic power of the investigated biochemical marker. The present study was conducted to verify this issue by employing a modified outcome score, which we termed as Modified Glasgow Outcome Score (MGOS). In the present study, 97 patients were enrolled in a prospective manner. Serum NSE and S100B levels were measured daily for 7 days after admission to the intensive care unit. Neurological outcome was assessed by employing the GOS and MGOS after 6 months. By employing the GOS, 46 patients were categorized into the group of patients with poor outcome and 51 patients survived with good neurological outcome. Patients who died without certified brain damage or with unknown cerebral status after CA (n = 20) were separated from patients with poor outcome in the MGOS. The magnitude of NSE (S100B) elevation in patients with poor outcome categorized by the MGOS was approximately 1.7-fold (1.5) higher as compared with patients divided by the GOS. The mean calculated sensitivities and area under the curve values of NSE and S100B predicting poor outcome classified by the MGOS were significantly higher as compared with the GOS. Conclusively, inclusion of deaths without certified brain damage or with unknown cerebral status into the group of patients with poor outcome will lead to underestimation of the prognostic power of investigated biochemical markers such as NSE and S100B. The MGOS will help to avoid this bias.

show abstract

Autonomic regulation during mild therapeutic hypothermia in cardiopulmonary resuscitated patients

Abstract: Resuscitated patients show a significantly reduced HRV before, during and after TH. Compared to survivors, the non-survivors show a further and significantly decrease of HRV immediately after hypothermia.

Cited by 8 publications

References 39 publications

Autonomic nervous system monitoring in intensive care as a prognostic tool. Systematic review

Autonomic nervous system monitoring in intensive care as a prognostic tool. Systematic review

Efficacy of enteral ticagrelor in hypothermic patients after out-of-hospital cardiac arrest

The Modified Glasgow Outcome Score for the prediction of outcome in patients after cardiac arrest: a prospective clinical proof of concept study

Contact Info

Product

Resources

About