Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era*

Mongardon, Nicolas; Parratte, Sébastien; Lemiale, Virginie; Dumas, Florence; Poupet, Hélène; Charpentier, Julien; Pène, Frédéric; Chiche, Jean‐Daniel; Mira, Jean‐Paul; Cariou, Alain

doi:10.1097/ccm.0b013e3182120b56

Cited by 180 publications

(119 citation statements)

References 38 publications

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“…9 Some publications, including meta-analyses, did not find any increased risks using TH, 5,36,37 but other authors observed a higher incidence of infections with cooling, mainly pneumonia. 17,[38][39][40] In the present study, minor side effects were observed more frequently with invasive cooling and were dominated by minor bleedings and venous catheter bacterial colonization without septic shock occurrence. The systematic microbiological cultures of all venous catheters and the higher number of venous accesses used in the endovascular group may have contributed to this result (Table VI in the online-only Data Supplement).…”

Section: Side Effectsmentioning

confidence: 99%

Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

et al. 2015

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Background— Targeted temperature management is recommended after out-of-hospital cardiac arrest. Whether advanced internal cooling is superior to basic external cooling remains unknown. The aim of this multicenter, controlled trial was to evaluate the benefit of endovascular versus basic surface cooling. Methods and Results— Inclusion criteria were the following: age of 18 to 79 years, out-of-hospital cardiac arrest related to a presumed cardiac cause, time to return of spontaneous circulation <60 minutes, delay between return of spontaneous circulation and inclusion <240 minutes, and unconscious patient after return of spontaneous circulation and before the start of cooling. Exclusion criteria were terminal disease, pregnancy, known coagulopathy, uncontrolled bleeding, temperature on admission <30°C, in-hospital cardiac arrest, immediate need for extracorporeal life support or hemodialysis. Patients were randomized between 2 cooling strategies: endovascular femoral devices (Icy catheter, Coolgard, Zoll, formerly Alsius; n=203) or basic external cooling using fans, a homemade tent, and ice packs (n=197). The primary end point, that is, favorable outcome evaluated by survival without major neurological damage (Cerebral Performance Categories 1–2) at day 28, was not significantly different between groups (odds ratio, 1.41; 95% confidence interval, 0.93–2.16; P =0.107). Improvement in favorable outcome at day 90 in favor of the endovascular group did not reach significance (odds ratio, 1.51; 95% confidence interval, 0.96–2.35; P =0.07). Time to target temperature (33°C) was significantly shorter and target hypothermia was more strictly maintained in the endovascular than in the surface group ( P <0.001). Minor side effects directly related to the cooling method were observed more frequently in the endovascular group ( P =0.009). Conclusion— Despite better hypothermia induction and maintenance, endovascular cooling was not significantly superior to basic external cooling in terms of favorable outcome. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00392639.

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Section: Side Effectsmentioning

confidence: 99%

Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

et al. 2015

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“…Evidence from stroke and TBI patients treated with TTM report increased incidence of pneumonia with TTM times exceeding 48-72 h [197,218] . Recent retrospective review of 421 patients from a single center demonstrated 67% of patients developed 373 infectious complications [219] . These were most commonly pneumonia (85%), bloodstream infections (9%), and catheter-related infections (3%).…”

Section: Logistics Of Deliverymentioning

confidence: 99%

Use of hypothermia in the intensive care unit

Corry¹

2012

WJCCM

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Used for over 3600 years, hypothermia, or targeted temperature management (TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited. Despite ample experimental data, clinical evidence for stroke, refractory status epilepticus, hepatic encephalopathy, and intensive care unit is only at the safety and proof-of-concept stage. This review explores the deleterious nature of fever, the theoretical role of TTM in the critically ill, and summarizes the clinical evidence for TTM in adults.

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“…(15,16) Owing to the active cooling process, recognition of fever is not possible. Pneumonia and sepsis have been found to be increased during hypothermia.…”

Section: Infectionsmentioning

confidence: 99%

Therapeutic temperature management (TTM): post-resuscitation care for adult cardiac arrest, with recommendations from the National TTM Workgroup

Leong¹,

Chan²,

Ho³

et al. 2017

smedj

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Therapeutic temperature management (TTM) was strongly recommended by the 2015 International Liaison Committee on Resuscitation as a component of post-resuscitation care. It has been known to be effective in improving the survival rate and neurologic functional outcome of patients after cardiac arrest. In an effort to increase local adoption of TTM as a standard of post-resuscitation care, this paper discusses and makes recommendations on the treatment for local providers.

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Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era*

Cited by 180 publications

References 38 publications

Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

Use of hypothermia in the intensive care unit

Therapeutic temperature management (TTM): post-resuscitation care for adult cardiac arrest, with recommendations from the National TTM Workgroup

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