Effects of Therapeutic Hypothermia on Left Ventricular Function Assessed by Ultrasound Imaging

Espinoza, Andreas; Kerans, Viesturs; Opdahl, Anders; Skulstad, Helge; Halvorsen, Per Steinar; Bugge, J. F.; Fosse, Erik; Edvardsen, Thor

doi:10.1016/j.echo.2013.06.021

Cited by 30 publications

(47 citation statements)

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“…This made it possible to assess both peak systolic and post systolic velocities which have been extensively validated as markers of regional left ventricular dysfunction and myocardial ischemia by tissue Doppler echocardiography [53,54]. Peak systolic myocardial velocity obtained from the ultrasonic transducers is unaffected by moderate changes in preload but has the sensitivity to detect changes in contractility [34,55,56]. The time-velocity trace was obtained with dedicated software from a range-gated volume sample at a fixed depth in the subendocardium (figure 2) as this layer of the ventricular wall is most vulnerable to coronary artery flow reduction and myocardial ischemia [57].…”

Section: Sensor Systems Epicardial Ultrasonic Systemmentioning

confidence: 99%

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Hyler

Pischke

Halvorsen

et al. 2015

Journal of the American Society of Echocardiography

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The epicardially attached miniaturized ultrasound transducer allowed the precise detection of different levels of coronary flow reduction. The results also showed a quantitative and linear relationship among coronary flow, ischemia, and myocardial function. Thus, the ultrasound transducer has the potential to improve the monitoring of myocardial ischemia and to detect graft failure during and after heart surgery.

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Section: Sensor Systems Epicardial Ultrasonic Systemmentioning

confidence: 99%

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Hyler

Pischke

Halvorsen

et al. 2015

Journal of the American Society of Echocardiography

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“…In contrast, TH has been shown to produce negative effects as well as cardioprotective effects. Espinoza et al showed that TH in pigs decreased SV, ejection fraction and strain in hearts paced at 33°C, and concluded that TH may lead to systolic and diastolic dysfunction [42]. When Bassin et al induced hypothermia in sheep using venous extracorporeal circulation, they observed increased heterogeneity in hypothermic depolarization and repolarization during cardiac rhythm tracking by 12-derivation ECG, thus providing strong evidence that hypothermia to 34°C produced adverse effects [43].…”

Section: Discussionmentioning

confidence: 99%

Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation

et al. 2014

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BackgroundHypothermia has been used in cardiac surgery for many years for neuroprotection. Mild hypothermia (MH) [body temperature (BT) kept at 32–35°C] has been shown to reduce both mortality and poor neurological outcome in patients after cardiopulmonary resuscitation (CPR). This study investigated whether patients who were expected to benefit neurologically from therapeutic hypothermia (TH) also had improved cardiac function.MethodsThe study included 30 patients who developed in-hospital cardiac arrest between September 17, 2012, and September 20, 2013, and had return of spontaneous circulation (ROSC) following successful CPR. Patient BTs were cooled to 33°C using intravascular heat change. Basal BT, systolic artery pressure (SAP), diastolic artery pressure (DAP), mean arterial pressure (MAP), heart rate, central venous pressure, cardiac output (CO), cardiac index (CI), global end-diastolic volume index (GEDI), extravascular lung water index (ELWI), and systemic vascular resistance index (SVRI) were measured at 36°C, 35°C, 34°C and 33°C during cooling. BT was held at 33°C for 24 hours prior to rewarming. Rewarming was conducted 0.25°C/h. During rewarming, measurements were repeated at 33°C, 34°C, 35°C and 36°C. A final measurement was performed once patients spontaneously returned to basal BT. We compared cooling and rewarming cardiac measurements at the same BTs.ResultsSAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). DAP values during rewarming (basal temperature, 34°C, 35°C and 36°C) were lower than during cooling. MAP values during rewarming (34°C, 35°C and 36°C) were lower than during cooling (P < 0.05). CO and CI values were higher during rewarming than during cooling. GEDI and ELWI did not differ during cooling and rewarming. SVRI values during rewarming (34°C, 35°C, 36°C and basal temperature) were lower than during cooling (P < 0.05).ConclusionsTo our knowledge, this is the first study comparing cardiac function at the same BTs during cooling and rewarming. In patients experiencing ROSC following CPR, TH may improve cardiac function and promote favorable neurological outcomes.

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“…As a consequence of lower temperature primarily during induction phase polyuria may occur resulting in hypovolemia [60]. Systolic and diastolic dysfunction was provoked in pigs while they were treated with hypothermia [61]. On the other hand these effects may be advantageous in this patient group because it has been shown that post-cardiac arrest patients with bradycardia had better outcome than patients whose heart rate was higher [62].…”

Section: Discussionmentioning

confidence: 99%

Strategies of Neuroprotection after Successful Resuscitation

Kovács¹,

Zima²

2017

Resuscitation Aspects

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Post-cardiac arrest syndrome (PCAS) incorporates post-cardiac arrest brain injury, postcardiac arrest myocardial dysfunction, systemic ischemia/reperfusion syndrome and the precipitating pathology. Brain injury remains the leading cause of death in the postcardiac arrest period. One of our main goals during post-resuscitation care is to guide a proper neuroprotective strategy. We are going to summarize the tools of neuroprotection in post-cardiac arrest therapy. The role of normoxia/normocapnia, normoglycemia, seizure control, sedation and pharmacologic strategies will be discussed in brief. The handling of temperature management and the management of hemodynamic variables to secure satisfactory cerebral perfusion will be worked out in details. Targeted temperature management is the main tool of neuroprotection in post-cardiac arrest therapy. We are going to conclude the principles of temperature control after successful resuscitation pointing out its beneficial effects. This method has also several complications that are going to be discussed highlighting its hemodynamic impacts. There is no evidence about target hemodynamic parameters during post-cardiac arrest syndrome to maintain cerebral perfusion neither about the most effective hemodynamic monitoring system. We are presenting preliminary data of our study where we investigate the effect of PiCCO™ (Pulse index Continous Cardiac Output) monitoring on the outcome in this patient group.Keywords: post-cardiac arrest syndrome, post-cardiac arrest brain injury, post-resuscitation therapy, targeted temperature management, hemodynamic parameters IntroductionSudden cardiac arrest is one of the leading causes of death in Europe [1]. The outcome is still very poor: the hospital discharge varies between 7 and 10% after out-of-hospital cardiac arrest (OHCA) and it is approximately 25% after in-hospital cardiac arrest (IHCA) [1]. The chain of © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.survival describes links that lead to a successful resuscitation [2]. The fourth element covers proper post-resuscitation care to restore quality of life. It is well known that the management of post-resuscitation cardiac arrest syndrome affects outcome and it is an important part of the resuscitation process. Pointing out the growing importance of post-resuscitation therapy, the European Resuscitation Council (ERC) introduced a separate chapter about post-resuscitation care in the 2015 guidelines [3]. One of the key elements to improve survival rate after sudden cardiac arrest may be the enhancement of post-resuscitation therapy.The post-cardiac arrest brain injury remains the main cause of mortality in the post-cardiac arrest period, being as high as 68% after OHCA and 25% after IHCA [4]. These data show that one of our leading goa...

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Effects of Therapeutic Hypothermia on Left Ventricular Function Assessed by Ultrasound Imaging

Cited by 30 publications

References 29 publications

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation

Strategies of Neuroprotection after Successful Resuscitation

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