Hypothermia After Cardiac Arrest

Felberg, Robert A.; Krieger, Derk; Chuang, Ru‐Jye; Persse, David; Burgin, W. Scott; Hickenbottom, Susan L.; Morgenstern, Lewis B.; Rosales, Oscar; Grotta, James C.

doi:10.1161/hc4001.097037

Cited by 130 publications

(26 citation statements)

References 42 publications

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“…(17)(18)(19)(20)(21) Ideal cooling procedures must quickly and practically reach the target temperature, without causing injuries.…”

Section: How To Cool the Patient?mentioning

confidence: 99%

“…(18) Application of ice packs has proven efficient, reducing on the average 0.9° C per hour of application. (19) Probably, the most practical and agile method is intravenous infusion of iced fluid (at 4°C). Rajek et al (20) administered iced saline solution (4°C) to volunteers at a speed of 40 mL/kg, 30 minutes by means of central catheter and it was possible to safely achieve a 5°C reduction of central temperature per hour.…”

Section: How To Cool the Patient?mentioning

confidence: 99%

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Hipotermia terapêutica pós-reanimação cardiorrespiratória: evidências e aspectos práticos

Feitosa-Filho¹,

Sena²,

Guimarães³

et al. 2009

Rev. bras. ter. intensiva

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Cardiac arrest survivors frequently suffer from ischemic brain injury associated with poor neurological outcome and death. Therapeutic hypothermia improves outcomes in comatose survivors after resuscitation from out-of-hospital cardiac arrest. Considering its formal recommendation as a therapy, post-return of spontaneous circulation after cardiac arrest, the objective of this study was to review the clinical aspects of therapeutic hypothermia. Non-systematic review of articles using the keywords "cardiac arrest, cardiopulmonary resuscitation, cooling, hypothermia, post resuscitation syndrome" in the MedLine database was performed. References of these articles were also reviewed. Unconscious adult patients with spontaneous circulation after out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia should be cooled. Moreover, for any other rhythm or in the intra-hospital scenario, such cooling may also be beneficial. There are different ways of promoting hypothermia. The cooling system should be adjusted as soon as possible to the target temperature. Mild therapeutic hypothermia should be administered under close control, using neuromuscular blocking drugs to avoid shivering. The rewarming process should be slow, and reach 36º C, usually in no less then 8 hours. When temperature increases to more than 35º C, sedation, analgesia, and paralysis could be discontinued. The expected complications of hypothermia may be pneumonia, sepsis, cardiac arrhythmias, and coagulopathy. In spite of potential complications which require rigorous control, only six patients need to be treated to save one life.

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“…(17)(18)(19)(20)(21) Ideal cooling procedures must quickly and practically reach the target temperature, without causing injuries.…”

Section: How To Cool the Patient?mentioning

confidence: 99%

Section: How To Cool the Patient?mentioning

confidence: 99%

Hipotermia terapêutica pós-reanimação cardiorrespiratória: evidências e aspectos práticos

Feitosa-Filho¹,

Sena²,

Guimarães³

et al. 2009

Rev. bras. ter. intensiva

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show abstract

“…Felberg et al reported a feasibility trial where external cooling was feasible and safe. However, external cooling was slow and imprecise and efforts to speed up the start of cooling and to improve the cooling process are needed (Felberg et al 2001).…”

Section: Hypothermia After Cardiac Arrestmentioning

confidence: 99%

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

Virkkunen¹

2009

Acta Anaesthesiol Scand

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“…Recent trials have administered sedative and neuromuscular blocking agents during the hypothermia interval. l4, 15,20,21 Neuromuscular blockade is given to prevent shivering during hypothermia. Modest hypothermia has been induced in un-intubated stroke patients without resorting to the use of neuromuscular blockade or sedation.…”

mentioning

confidence: 99%

“…Multiple techniques of hypothermia induction have been published including: application of ice packs; 5 surface cooling with cooled forced-air, 4,20 or circulating water blankets; 18,19 infusion of 4°C iv fluids; [26][27][28] immersion in cold water; 29 specialized endovascular cooling devices; 21,30,31 and cardiopulmonary bypass. 32 No trials comparing hypothermia techniques in cardiac arrest patients have been published.…”

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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Hypothermia After Cardiac Arrest

Cited by 130 publications

References 42 publications

Hipotermia terapêutica pós-reanimação cardiorrespiratória: evidências e aspectos práticos

Hipotermia terapêutica pós-reanimação cardiorrespiratória: evidências e aspectos práticos

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

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

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