Concordance of Brain and Core Temperature in Comatose Patients After Cardiac Arrest

Coppler, Patrick J; Marill, Keith A.; Okonkwo, David O.; Shutter, Lori; Dezfulian, Cameron; Rittenberger, Jon C.; Callaway, Clifton W.; Elmer, Jonathan

doi:10.1089/ther.2016.0010

Cited by 32 publications

(15 citation statements)

References 14 publications

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“…From the physiological point of view, brain temperature should be the priority monitoring site for survivors with TTM. With the fact that the jugular bulb blood is derived from intracerebral vasculature, the jugular vein temperature has been considered as an accurate index of cerebral cortical temperature in various studies [ 8 , 9 ]. However, both brain cortex and jugular vein temperature are not so easily detected and insufficient data of temperature value may lead to delay initiation and insufficient or excessive TTM.…”

Section: Discussionmentioning

confidence: 99%

Is Esophageal Temperature Better to Estimate Brain Temperature during Target Temperature Management in a Porcine Model of Cardiopulmonary Resuscitation?

Yang

Liu

et al. 2017

BioMed Research International

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Brain temperature monitoring is important in target temperature management for comatose survivors after cardiac arrest. Since acquisition of brain temperature is invasive and unrealistic in scene of resuscitation, we tried to sought out surrogate sites of temperature measurements that can precisely reflect cerebral temperature. Therefore, we designed this controlled, randomized animal study to investigate whether esophageal temperature can better predict brain temperature in two different hypothermia protocols. The results indicated that esophageal temperature had a stronger correlation with brain temperature in the early phase of hypothermia in both whole and regional body cooling protocols. It means that esophageal temperature was considered as priority method for early monitoring once hypothermia is initiated. This clinical significance of this study is as follows. Since resuscitated patients have unstable hemodynamics, collecting temperature data from esophagus probe is cost-efficient and easier than the catheter in central vein. Moreover, it can prevent the risk of iatrogenic infection comparing with deep vein catheterization, especially in survivors with transient immunoexpressing in hypothermia protocol.

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Section: Discussionmentioning

confidence: 99%

Is Esophageal Temperature Better to Estimate Brain Temperature during Target Temperature Management in a Porcine Model of Cardiopulmonary Resuscitation?

Yang

Liu

et al. 2017

BioMed Research International

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“…It is crucial to continuously monitor core body temperature during therapeutic hypothermia and targeted temperature management as it closely correlates with brain temperature 69 . Measurement of the central venous temperature is considered the gold standard.…”

Section: Determining the Etiologymentioning

confidence: 99%

State‐of‐the‐art considerations in post‐arrest care

Sonnier

Rittenberger

2020

JACEP Open

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Cardiac arrest has a high rate of morbidity and mortality. Several advances in postcardiac arrest management can improve outcome, but are time-dependent, placing the emergency physician in a critical role to both recognize the need for and initiate therapy. We present a novel perspective of both the workup and therapeutic interventions geared toward the emergency physician during the first few hours of care. We describe how the immediate care of a post-cardiac arrest patient is resource intensive and requires simultaneous evaluation for the underlying cause and intensive management to prevent further end organ damage, particularly of the central nervous system.The goal of the initial focused assessment is to rapidly determine if any reversible causes of cardiac arrest are present and to intervene when possible. Interventions performed in this acute period are aimed at preventing additional brain injury through optimizing hemodynamics, providing ventilatory support, and by using therapeutic hypothermia when indicated. After the initial phase of care, disposition is guided by available resources and the clinician's judgment. Transfer to a specialized cardiac arrest center is prudent in centers that do not have significant support or experience in the care of these patients.

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“…Regardless of the target temperature, an accurate temperature control during MTH is required [7]. Measurement of central circulation temperature or brain tissue temperature is difficult to apply in an emergency setting, therefore surrogate sites such as urinary bladder, rectum, tympanic membrane, or esophagus, are often used [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Comparison of temperature measurements in esophagus and urinary bladder in comatose patients after cardiac arrest undergoing mild therapeutic hypothermia

et al. 2020

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Background: Mild therapeutic hypothermia (MTH) is a recommended method of treatment for comatose out-of-hospital cardiac arrest (OHCA) survivors. However, the proper site of temperature measurement in MTH is still not defined. The aim of this study was to compare temperature measurements in the esophagus and urinary bladder in comatose post-OHCA patients treated with MTH. Methods: This temperature comparison protocol was a part of a prospective, observational, multicenter cohort study. The study population included 36 unconscious patients after resuscitation for OHCA. The patient's core temperature was independently measured every hour during MTH in the urinary bladder and in the esophagus. Results: The mean temperature was lower in the esophagus (differences during induction phase: 1.04 ± 0.92°C, p < 0.0001; stabilization phase: 0.54 ± 0.39°C, p < 0.0001; rewarming phase: 0.40 ± 0.47°C, p < 0.0001). Nevertheless, a strong correlation between both sites was found (R 2 = 0.83, p < 0.001). The decrease in temperature observed in the esophagus during the induction phase was faster when compared with the urinary bladder (1.09 ± 0.71°C/h vs. 0.83 ± 0.41°C/h; p = 0.002). As a consequence, time to reach temperature < 34.0°C was longer when temperature was measured in the urinary bladder (the difference between medians of the time 1.0 [0-1.5] h, p < 0.001). Conclusions: Urinary bladder temperature measurements may lag behind temperature changes measured in the esophagus. Monitoring temperature simultaneously in the esophagus and in the urinary bladder is an accessible and reliable combination, although esophageal measurements seem to better reflect the dynamics of temperature changes, thus it seems to be more appropriate for MTH control. ClinicalTrials.gov Identifier: NCT02611934. (Cardiol J XXXX; XX, X: xx-xx)

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Concordance of Brain and Core Temperature in Comatose Patients After Cardiac Arrest

Cited by 32 publications

References 14 publications

Is Esophageal Temperature Better to Estimate Brain Temperature during Target Temperature Management in a Porcine Model of Cardiopulmonary Resuscitation?

Is Esophageal Temperature Better to Estimate Brain Temperature during Target Temperature Management in a Porcine Model of Cardiopulmonary Resuscitation?

State‐of‐the‐art considerations in post‐arrest care

Comparison of temperature measurements in esophagus and urinary bladder in comatose patients after cardiac arrest undergoing mild therapeutic hypothermia

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