Capillary leakage in post-cardiac arrest survivors during therapeutic hypothermia - a prospective, randomised study

Abstract

BackgroundFluids are often given liberally after the return of spontaneous circulation. However, the optimal fluid regimen in survivors of cardiac arrest is unknown. Recent studies indicate an increased fluid requirement in post-cardiac arrest patients. During hypothermia, animal studies report extravasation in several organs, including the brain. We investigated two fluid strategies to determine whether the choice of fluid would influence fluid requirements, capillary leakage and oedema formation.Methods19 survivors with witnessed cardiac arrest of primary cardiac origin were allocated to either 7.2% hypertonic saline with 6% poly (O-2-hydroxyethyl) starch solution (HH) or standard fluid therapy (Ringer's Acetate and saline 9 mg/ml) (control). The patients were treated with the randomised fluid immediately after admission and continued for 24 hours of therapeutic hypothermia.ResultsDuring the first 24 hours, the HH patients required significantly less i.v. fluid than the control patients (4750 ml versus 8010 ml, p = 0.019) with comparable use of vasopressors. Systemic vascular resistance was significantly reduced from 0 to 24 hours (p = 0.014), with no difference between the groups. Colloid osmotic pressure (COP) in serum and interstitial fluid (p < 0.001 and p = 0.014 respectively) decreased as a function of time in both groups, with a more pronounced reduction in interstitial COP in the crystalloid group. Magnetic resonance imaging of the brain did not reveal vasogenic oedema.ConclusionsPost-cardiac arrest patients have high fluid requirements during therapeutic hypothermia, probably due to increased extravasation. The use of HH reduced the fluid requirement significantly. However, the lack of brain oedema in both groups suggests no superior fluid regimen. Cardiac index was significantly improved in the group treated with crystalloids. Although we do not associate HH with the renal failures that developed, caution should be taken when using hypertonic starch solutions in these patients.Trial registrationNCT00347477.

Effect of Topical Anaesthetics on Interstitial Colloid Osmotic Pressure in Human Subcutaneous Tissue Sampled by Wick Technique

“…Saline soaked wicks are commonly used in human studies [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] and from our own pilot studies, they cause less pain than dry wicks during insertion. Four wicks were inserted subcutaneously in the same position on each upper arm.…”

Repeated magnetic resonance imaging and cerebral performance after cardiac arrest—A pilot study

“…6 The cardiovascular status in our patients did not differ during the first 24 h between these patients and those with normal MRI after hypothermia. 11 DWI changes induced by global hypoxic cerebral injury in humans may evolve slowly, with a peak reported after 2-4.5 days. 8 Therefore, quantitative DWI with ADC measurements obtained between 49 and 108 h after the arrest appear to best differentiate survivors from those who die.…”

“…The patients were cooled and included in a fluid study, described elsewhere. 11 All patients had to be provided with advanced medical life support within 15 min, gained return of spontaneous circulation within 60 min and still be comatose upon arrival at the hospital. Patients strongly in need of nursing before the arrest, suffering a primary coagulopathy or given >2000 ml of fluid upon admittance were excluded.…”

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 6: Post‐cardiac arrest care

“…PCA hypovolemia despite positive fluid balance in OHCA patients was identified by transthoracic echocardiography in a small clinical observational study . Heradstveit et al (LOE 6, fair/neutral) identified transvascular fluid leakage, decreased colloid osmotic pressure, and low systemic vascular resistance in the postresuscitation phase as reasons for the need for IV fluid administration in PCA patients . In human studies using standardized resuscitation protocols (LOE 6, fair or poor/neutral), large volumes of IV fluids (3‐13 L/person) during the first 24 hours after ROSC were required to meet predefined hemodynamic endpoints , .…”