Influence of the temperature on the moment of awakening in patients treated with therapeutic hypothermia after cardiac arrest

Ponz, Ines; Lopez-de-Sa, Esteban; Armada, Eduardo; Caro, Juan; Blazquez, Zorba; Rosillo, Sandra; González, O.; Rey, J.; Monedero, Maria del Carmen; López‐Sendón, José

doi:10.1016/j.resuscitation.2016.03.017

Cited by 34 publications

(26 citation statements)

References 15 publications

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“…In one study (n = 163), mean time of awakening for these patients was 3.8 days and 21% of them regained neurological responsiveness after 5 days from arrest, in particular if cooled at lower target temperatures (32-33°C) [21]. Moreover, renal insufficiency, older age and post-resuscitation shock were the most important determinants of delayed awakening in these patients [22].…”

Section: When To Start Neuroprognostication?mentioning

confidence: 97%

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Taccone¹,

Colpaert²,

Waele³

et al. 2015

Resuscitation

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The prognosis of patients who are admitted to the hospital after cardiac arrest often relies on neurological examination, which could be significantly influenced by the use of sedative drugs or the implementation of targeted temperature management. The need for early and accurate prognostication is crucial as up to 15-20% of patients could be considered as having a poor outcome and may undergo withdrawal of life-sustaining therapies while a complete neurological recovery is still possible. As current practice in Belgium is still based on a very early assessment of neurological function in these patients, the Belgian Society of Intensive Care Medicine created a multidisciplinary Task Force to provide an optimal approach for monitoring and refine prognosis of CA survivors. This Task Force underlined the importance to use a multimodal approach using several additional tools (e.g., electrophysiological tests, neuroimaging, biomarkers) and to refer cases with uncertain prognosis to specialized centers to better evaluate the extent of brain injury in these patients.

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Section: When To Start Neuroprognostication?mentioning

confidence: 97%

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Taccone¹,

Colpaert²,

Waele³

et al. 2015

Resuscitation

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“…Recovery of ceased neurological functions can be delayed as long as 278 h after discontinuing sedative drugs and neuro-protective therapy (targeted temperature management) (Paul et al 2016 ). Therefore, a minimum waiting time of no less than 120 h has been recommended before determining the irreversibility of hypoxic–ischemic brain injury (Ponz et al 2016 ). If reversible suppression of brainstem reflexes is mistaken as irreversible cessation of brainstem function, neurological death is determined incorrectly (Joffe et al 2009 ; Webb and Samuels 2011 ).…”

Section: A Medico-ethical Critiquementioning

confidence: 99%

“…It is difficult to prognose the neurological outcome or the future quality of a child’s life early after hypoxic–ischemic brain injury. Several studies (Gold et al 2014 ; Ponz et al 2016 ) have cautioned against an early withdrawal of life-support because of serious errors in prediction of a neurological prognosis after acute hypoxic–ischemic brain injury.…”

Section: A Medico-ethical Critiquementioning

confidence: 99%

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Choong

Rady

2016

HEC Forum

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The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological (brainstem) death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A (A Child) [2015] EWHC 443 (Fam). Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: (1) the tests of brainstem function were not properly undertaken in this case; (2) the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and (3) absent authentication of the clinical criteria of death, the code of practice (in fact, although implicitly rather than explicitly) wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A (A Child) is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society.Electronic supplementary materialThe online version of this article (doi:10.1007/s10730-016-9307-y) contains supplementary material, which is available to authorized users.

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“…After arrest, residual sedation or paralysis confounds the clinical examination [63]. One study showed that patients undergoing TTM ( ≤ 33°C) recovered consciousness in a mean of 3.8 days, with approximately 20% awakening after 5 days postarrest [64]. Recently, Rey et al [65] reported that increased utilization of midazolam during the TTM phase correlates with late awakening (median time to awakening 5 days; range, 3 to 23 days from sedation stop).…”

Section: Analgosedationmentioning

confidence: 99%

Targeted temperature management for postcardiac arrest syndrome

Kuroda

Kawakita

2020

J Neurocrit Care

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Neurocritical care management to improve neurologic outcome for postcardiac arrest syndrome (PCAS) has focused considerably on targeted temperature management (TTM). TTM attenuates the destructive processes following ischemia/reperfusion in PCAS. The principal indication of TTM is a patient with sustained coma after return of spontaneous circulation (ROSC). TTM can be strongly recommended with a target temperature between 32°C and 36°C for patients with shockable rhythm and out-of-hospital cardiac arrest (OHCA) and weakly recommended for patients with initial asystole or pulseless electrical activity with OHCA and those with in-hospital cardiac arrest. TTM is induced and maintained using a cooling device with body temperature feedback under appropriate analgosedation. It requires the intensive management of various systemic respiratory, circulatory, and metabolic parameters that control shivering to prevent secondary brain damage. Considering the cerebral perfusion pressure, it is suggested that the mean arterial pressure should be particularly maintained over 80 mm Hg. Seizure management, including continuous electroencephalography monitoring, is also needed. Finally, we must continue the above mentioned care during and after the rewarming phase, because high fever and shivering may appear again during this period. Furthermore, neurological prognostication should be performed at least 72 hours after ROSC through clinical investigations and multimodal testing without sedation.

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Influence of the temperature on the moment of awakening in patients treated with therapeutic hypothermia after cardiac arrest

Cited by 34 publications

References 15 publications

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Targeted temperature management for postcardiac arrest syndrome

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