Efficacy of therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation

Belliard, Guillaume; Catez, Emmanuel; Charron, Cyril; Caille, Vincent; Aegerter, Philippe; Dubourg, Olivier; Jardin, François; Vieillard‐Baron, Antoine

doi:10.1016/j.resuscitation.2007.04.014

Cited by 135 publications

(53 citation statements)

References 27 publications

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“…Two studies with historical control groups (LOE 3) showed improvement in neurological outcome after therapeutic hypothermia for comatose survivors of VF cardiac arrest. 824,825 One systematic review demonstrated that conventional cooling methods were more likely to reach a best cerebral performance category score of 1 or 2 (5-point scale where 1 is good and 5 is brain death) with a relative risk of 1.55 (99.5% CI 1.22 to 1.96) and more likely to survive to hospital discharge (relative risk of 1.35 95% CI 1.1 to 1.65) compared with standard postresuscitation care (LOE 1). 826 One small (nϭ30) randomized trial showed reduced plasma lactate values and oxygen extraction ratios in a group (nϭ16) of comatose survivors after cardiac arrest with asystole or PEA who were cooled with a cooling cap (LOE 1).…”

Section: Consensus On Sciencementioning

confidence: 99%

“…Six studies indicated that cooling with IV cold saline can be initiated in the prehospital phase (LOE 1 781,844 ; LOE 2 845 ; LOE 3 261,846 748,841,850,[853][854][855]. Seven studies documented the use of ice packs (sometimes combined with wet towels) alone to induce and maintain hypothermia (LOE 2 823 ; LOE 3 824,828,830 ; LOE 4 847,849,856 ). Four studies documented the use of ice packs alone to maintain hypothermia (LOE 3 837 ; LOE 4 810,840,843 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

See 1 more Smart Citation

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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Section: Consensus On Sciencementioning

confidence: 99%

Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

View full text Add to dashboard Cite

“…[16][17][18][19][20][21] The original trials excluded patients in cardiogenic shock. 5,6 Subsequent observational studies have variably included patients in cardiogenic shock.…”

Section: N Discussionmentioning

confidence: 99%

“…Though there is less agreement, older age, lower Glasgow Coma Scale score, and unwitnessed arrest have also all been reported as prognostic of unfavorable outcome. [20][21][22][23] Given that this was a retrospective data analysis and similar to other literature, we used the use of vasopressors or an assist device to define the presence of shock. To our knowledge, no other previous studies defined criteria for the etiology of shock at temperatures other than 378.…”

Section: N Discussionmentioning

confidence: 99%

Incidence, Etiology, and Implications of Shock in Therapeutic Hypothermia

Paufler¹,

Newell²,

Hildebrandt³

et al. 2017

Journal of the Minneapolis Heart Institute Foundation

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To identify the incidence and etiology of shock and implications on mortality and neurologic outcome in patients undergoing therapeutic hypothermia after cardiac arrest. Retrospective chart review of 206 consecutive patients from January 2006 through December 2010. The incidence of shock was 74.8% during cooling and 78.0% during rewarming. The most common etiology of shock during cooling was cardiogenic (46.1%). During rewarming, the etiology of shock was more distributed with 26.9% of patients in cardiogenic shock, 16.8% distributive, and 10.7% classified as mixed. There were no significant associations between shock during cooling or rewarming and survival (P ¼ 0.202, P ¼ 0.107) or neurologic score at discharge (P ¼ 0.377, P ¼ 0.055). Shock is difficult to categorize in the setting of therapeutic hypothermia. The incidence of shock in patients undergoing therapeutic hypothermia is high but not associated with poorer survival or worse neurologic score at discharge. Thus, the presence of shock should not be the limiting factor in decisions regarding aggressive care of the out-of-hospital cardiac arrest patient. KEY WORDStherapeutic hypothermia, shock, cardiac arrest, survival, neurologic outcome. n INTRODUCTIONEach year approximately 350,000 people have an out-of-hospital cardiac arrest (OHCA) in the United States.1 In a large meta-analysis, only 23.8% of patients survived to hospital admission and only 7.6% to hospital discharge.2 Prior to therapeutic hypothermia, 25% of the survivors had a poor neurologic outcome. 3The American Heart Association now recommends therapeutic hypothermia for 12 to 24 hours after out-of-hospital ventricular tachycardia/ventricular fibrillation (VT/VF) cardiac arrest as a method to improve neurologic outcomes. 4 This recommendation was based on 2 randomized controlled trials suggesting clear benefit of therapeutic hypothermia. 5,6Therapeutic hypothermia's role in patients presenting in shock is less well defined in the literature. Several small studies have addressed outcomes in patients in shock undergoing therapeutic hypothermia. In 1 study of 50 patients with OHCA secondary to VF undergoing therapeutic hypothermia, patients treated with an intra-aortic balloon pump were compared with those not requiring a balloon pump. Both sets of patients did relatively well with favorable neurologic score, defined as cerebral performance category 1 (good cerebral performance: conscious, alert, able to work, might have mild neurologic or psychologic deficit) or 2 (moderate cerebral disability: conscious, sufficient cerebral function for independent activities of daily life, able to work in sheltered environment), in 61% and 74% (P¼ NS).7 A second study reported the results of 56 patients, 28 with cardiogenic shock, after OHCA with any initial rhythm. In patients with cardiogenic shock, 39% had a favorable neurologic outcome at discharge whereas 71% of the patients not in cardiogenic shock had a favorable neurologic outcome.8 Mooney et al 9 previously described a 38% survival to hospital...

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“…1 Therapeutic hypothermia (TH) is a well-established method which has shown a positive impact on these outcomes. [2][3][4] The European Society of Cardiology strongly recommends the use of TH early after resuscitation of CA patients presenting acute myocardial infarction with ST-segment elevation (class I, evidence B) who are comatose or under deep sedation. 5 Similarly, the recent European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-Resuscitation Care 2015 recommend active cooling of patients after CA.…”

Section: Introductionmentioning

confidence: 99%