Hyperthermia After Cardiac Arrest Is Associated With an Unfavorable Neurologic Outcome

Zeiner, Andrea; Hölzer, Michael; Sterz, Fritz; Schörkhuber, Waltraud; Eisenburger, Philip; Havel, Christof; Kliegel, Andreas; Laggner, Anton N.

doi:10.1001/archinte.161.16.2007

Cited by 426 publications

(235 citation statements)

References 27 publications

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“…Only half of the febrile episodes are attributable to infection, with nosocomial pulmonary infections representing the largest contributor [19]. Observational and retrospective studies have demonstrated that fever is associated with poor neurological outcome in the first 72 h after cardiac arrest [20,21], stroke [22], intracerebral hemorrhage [23], subarachnoid hemorrhage [24], and traumatic brain injury [25][26][27]. In spinal cord injuries, animal studies have revealed that induced hyperthermia immediately after the injury is associated with increased tissue damage and worse outcomes compared to normothermic conditions [28].…”

Section: Detrimental Effects Of Fevermentioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

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Section: Detrimental Effects Of Fevermentioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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“…The message from this study is not that we should abandon temperature control; patients in both arms of the trial had their temperature controlled and, most importantly, fever, which is associated with poor neurological outcome after cardiac arrest [18], was prevented. Even after return to normothermia after a period of TH, continued temperature control is important.…”

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confidence: 99%

Therapeutic hypothermia and coronary angiography are mandatory after out-of-hospital cardiac arrest: Yes

Nolan

Cariou

2014

Intensive Care Med

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Finding the cause of out-of-hospital cardiac arrest (OHCA) is generally considered to be useful in order to prevent recurrence and subsequent clinical deterioration. As acute coronary syndrome (ACS) is a frequent cause of OHCA, several experts claim that resuscitated patients of presumed cardiac cause should undergo immediate coronary angiography with subsequent percutaneous coronary intervention (PCI) if indicated, regardless of clinical symptoms and/or electrocardiogram (ECG) criteria [1]. This strategy is supported by several strong arguments. First, there is a very high prevalence of coronary lesions in these arrest patients. In a recent metaanalysis, the prevalence of significant coronary artery disease ranged from 59 to 71 % in patients without an obvious non-cardiac aetiology (Table 1) [2]. This high prevalence of recent coronary occlusion provides a strong rationale for performing coronary angiography in OHCA patients with no obvious extra-cardiac cause, in order to detect the culprit lesion. Second, early coronary angiography also enables immediate PCI, when indicated. Since the publication of the pioneering study by Spaulding and co-workers in 1997 [3], many observational studies have reported the feasibility and possible survival benefit from an early invasive approach. In a cohort of 435 OHCA patients without obvious extra-cardiac cause, successful PCI was an independent factor for survival, regardless of the post-resuscitation ECG findings (odds ratio (OR) 2.1 [95 % confidence interval (CI) 1.2-3.7]) [4]. In this issue, Bougouin and colleagues [5] report on the characteristics of 3,816 cases of treated OHCA in Paris; after adjustment for other prognostic factors, coronary angiography was associated with survival (OR 2.4, 95 % CI 1.4-4.0, P = 0.001). As the data are derived from a 'real-life', large, population-based registry, this result underlines that the benefit of early reperfusion is not restricted to specialised 'cardiac arrest centres'. Finally early PCI is also associated with a better long-term outcome: among 1,001 OHCA survivors discharged from hospital in the USA, Dumas and associates reported a 5-year survival of 78.7 % in those treated with PCI compared with 54.4 % in those not treated with PCI (p \ 0.01). Moreover, PCI was associated with a lower risk of death after adjustment for confounders (hazard ratio 0.56 [95 % CI 0.34, 0.61], p \ 0.01) [6]. The benefit of early revascularization may not be restricted to crude survival but could also be associated with an improved quality of life. Specifically focusing on quality of life, daily functioning and participation in social activities, in a long-term follow-up of 63 OHCA survivors (after a mean follow-up of 36 ± 18.8 months) PCI was associated with better cognitive function, participation in social activities and instrumental daily activities compared with patients not treated with PCI [7]. Even in the absence of large randomised studies, it is highly probable that early coronary revascularisation, when required, is associated with a c...

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“…4,5,[7][8][9] Some benefits of hypothermia may result from avoidance of hyperthermia as temperatures over 37°C are common in post-arrest patients and are associated with increased risk of unfavourable neurologic recovery. 7 In fact, in post-arrest patients each degree Celsius over 37 is associated with increased risk of severe disability, coma, or persistent vegetative state. 7 These data are the basis for the recommendation to avoid hyperthermia 10 (temperatures over 38°C; Grade B), and to institute treatment to avoid temperatures over 37°C (Grade D).…”

mentioning

confidence: 99%

“…7 In fact, in post-arrest patients each degree Celsius over 37 is associated with increased risk of severe disability, coma, or persistent vegetative state. 7 These data are the basis for the recommendation to avoid hyperthermia 10 (temperatures over 38°C; Grade B), and to institute treatment to avoid temperatures over 37°C (Grade D). Gradual rewarming was practiced in the post-arrest hypothermia randomized controlled trials, 4,5 and is supported by data from hypothermic head injured patients 11 (Grade B).…”

mentioning

confidence: 99%

Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

Bell

Brindley

Forrest

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.S So ou ur rc ce e: : Prior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : High grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol·L -1 using insulin infusions, and PaO 2 > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.C Co on nc cl lu us si io on ns s: : The proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research. Objectif : Proposer une stratégie de traitement à adopter avec les patients admis aux unités de soins intensifs (USI) après la réanimation post-arrêt cardiaque. Source : Avant la conférence, les études utiles ont été repérées dans les publications et de brèves revues ont circulé sur

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Hyperthermia After Cardiac Arrest Is Associated With an Unfavorable Neurologic Outcome

Abstract: Hyperthermia is a potential factor for an unfavorable functional neurologic recovery after successful cardiopulmonary resuscitation.

Cited by 426 publications

References 27 publications

Therapeutic Hypothermia for Acute Neurological Injuries

Therapeutic Hypothermia for Acute Neurological Injuries

Therapeutic hypothermia and coronary angiography are mandatory after out-of-hospital cardiac arrest: Yes

Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

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