Improving neurological outcome after cardiac arrest: Therapeutic hypothermia the best treatment

Abstract

Cardiac arrest, irrespective of its etiology, has a high mortality. This event is often associated with brain anoxia which frequently causes severe neurological damage and persistent vegetative state. Only one out of every six patients survives to discharge following in-hospital cardiac arrest, whereas only 2-9% of patients who experience out of hospital cardiac arrest survive to go home. Functional outcomes of survival are variable, but poor quality survival is common, with only 3-7% able to return to their previous level of functioning. Therapeutic hypothermia is an important tool for the treatment of post-anoxic coma after cardiopulmonary resuscitation. It has been shown to reduce mortality and has improved neurological outcomes after cardiac arrest. Nevertheless, hypothermia is underused in critical care units. This manuscript aims to review the mechanism of hypothermia in cardiac arrest survivors and to propose a simple protocol, feasible to be implemented in any critical care unit.

Neurological outcome after cardiac arrest: a prospective study of the predictive ability of prognostic biomarkers neuron-specific enolase, glial fibrillary acidic protein, S-100B, and procalcitonin

“…Early determination of neurological prognosis would help us to detect the patients that would not be harmed by, and would probably benefit from, neuroprotective methods at an early stage, contributing to the good management of the treatment process. Consequently, it would provide a decrease in morbidity and mortality rates (5,6).…”

The critically ill brain after cardiac arrest

“…8,26 Hypothermia may also limit cardiac injury by reducing the metabolic demand of cardiac cells, preventing abnormal remodeling of the heart, and potentially decreasing the incidence of heart failure. [29][30][31] As with any intervention, hypothermia is not without side effects. The recommended protocol may be split into three different phases, and each phase presents its own set of potential complications.…”

“…These sites include the hippocampus, cerebellum, basal ganglia, cortex, and thalamus (see Table 2). 8,10,29 Disorders of consciousness and alertness (largely mediated by the cortex, thalamus, and brainstem) are often the most evident and distressing clinical feature in the early acute phase of injury. 1 Patients may not be alert or aware of their surroundings and may be unable to interact meaningfully; in severe cases, patients may be comatose.…”

Efficacy of AutoPulse for Mechanical Chest Compression in Patients with Shock-Resistant Ventricular Fibrillation

“…Sudden cardiac arrest (SCA) is one of the most common causes of death, with only 2–9% of SCA patients surviving until being discharged from the hospital [ 1 ]. Effective basic life support (BLS) provided until the arrival of a qualified ambulance team at the scene and further advanced life support (ALS) are the most important factors that increase the survival of patients with out-of-hospital cardiac arrest (OHCA) [ 2 ].…”