Mild hypothermia cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs

Sterz, Fritz; Šafář, Peter; Tisherman, Samuel A.; Radovsky, Ann; Kuboyama, Kazutoshi; Oku, Ken-ichi

doi:10.1097/00003246-199103000-00017

Cited by 311 publications

(144 citation statements)

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“…There have also been several previous studies with historical controls [25][26][27] considered as GOE IV, and experimental studies. [28][29][30][31] Recently, several observational studies, with historical controls [32][33][34][35] (GOE IV), uncontrolled studies 36,37 (GOE V) and a European registry 39 (GOE V), all show that MTH is feasible, safe, has few side effects and seems to contribute toward improved survival.…”

Section: Resultsmentioning

confidence: 99%

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Castrèn¹,

Silfvast²,

Rubertsson³

et al. 2009

Acta Anaesthesiol Scand

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Background and aim: Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).Methods: Relevant studies were identified after two consensus meetings of the SSAI Task Force on Therapeutic Hypothermia (SSAITFTH) and via literature search of the Cochrane Central Register of Controlled Trials and Medline. Evidence was assessed and consensus opinion was used when high‐grade evidence (Grade of Recommendation, GOR) was unavailable. A management strategy was developed as a consensus from the evidence and the protocols in the participating countries.Results and conclusion: Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic factors.

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Section: Resultsmentioning

confidence: 99%

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Castrèn¹,

Silfvast²,

Rubertsson³

et al. 2009

Acta Anaesthesiol Scand

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“…Indeed in mice submitted to asphyxia (where spontaneous hypothermia is noted), forced rewarming increases mortality and histological injuries in the various brain areas during the fi rst 72 hours 17 . In dogs submitted to experimental ventricular fi brillation (20 minutes period of absence of circulation), induction of hypothermia reduces the observed neurological defi cits, as well as encephalic histological alterations 18 .…”

Section: Temperaturementioning

confidence: 99%

Abordagem do paciente reanimado, pós-parada cardiorrespiratória

Pereira¹

2008

Rev. bras. ter. intensiva

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SUMMARY BACKGROUND AND OBJECTIVES:Out-of-hospital cardiac arrest is a major cause of death with survival rates as low as 5% to 35%. A large number of patients who survive resuscitation will face significant neurological damage, as a result of the ischemia that occurs both during cardiac arrest and reperfusion. However understanding of the mechanisms responsible for brain damage has not resulted in prognostic improvement. Therapeutic hypothermia after resuscitation may be a valid option associated to reduction of neurological damage. The purpose of this study was to review scientific evidence related to a therapy for patients resuscitated from cardiac arrest. CONTENTS: Description and analysis of the main risk factors associated with neurological damage after resuscitation from cardiac arrest as well as prognostic criteria was carried out. A non-systematic search was conducted in the PubMed data base for papers on a therapeutic approach for patients resuscitated from cardiac arrest. Bibliographic references of reviewed papers were also analyzed. Practical rules were drafted for such an approach.

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“…Laboratory studies suggest that neurologic injury is significantly decreased if cooling is initiated as soon as possible after resuscitation. [19][20][21][22] Five Class I studies and 1 Class II study investigated optimal timing of TH induction after resuscitation, full details of which are available in the complete guideline.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation

et al. 2017

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Objective: To assess the evidence and make evidence-based recommendations for acute interventions to reduce brain injury in adult patients who are comatose after successful cardiopulmonary resuscitation.Methods: Published literature from 1966 to August 29, 2016, was reviewed with evidencebased classification of relevant articles. Results and recommendations:For patients who are comatose in whom the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32-348C for 24 hours) is highly likely to be effective in improving functional neurologic outcome and survival compared with non-TH and should be offered (Level A). For patients who are comatose in whom the initial cardiac rhythm is either VT/VF or asystole/pulseless electrical activity (PEA) after OHCA, targeted temperature management (368C for 24 hours, followed by 8 hours of rewarming to 378C, and temperature maintenance below 37.58C until 72 hours) is likely as effective as TH and is an acceptable alternative (Level B). For patients who are comatose with an initial rhythm of PEA/asystole, TH possibly improves survival and functional neurologic outcome at discharge vs standard care and may be offered (Level C). Prehospital cooling as an adjunct to TH is highly likely to be ineffective in further improving neurologic outcome and survival and should not be offered (Level A). Other pharmacologic and nonpharmacologic strategies (applied with or without concomitant TH) are also reviewed. Neurology ® 2017;88:2141-2149 GLOSSARY AAN 5 American Academy of Neurology; AE 5 adverse event; CI 5 confidence interval; CPC 5 Cerebral Performance Category; CPR 5 cardiopulmonary resuscitation; ECMO 5 extracorporeal membrane oxygenation; HF 5 hemofiltration; IHCA 5 in-hospital cardiac arrest; OHCA 5 out-of-hospital cardiac arrest; PEA 5 pulseless electrical activity; RD 5 risk difference; ROSC 5 return of spontaneous circulation; TH 5 therapeutic hypothermia; TTM 5 targeted temperature management; VT 5 ventricular tachycardia; VF 5 ventricular fibrillation.Outcomes for patients after nontraumatic cardiac arrest are dismal. Only 6%-9.6% of all patients with out-of-hospital cardiac arrest (OHCA) survive to hospital discharge, 1,2 and an estimated 22.3% of patients with in-hospital cardiac arrest (IHCA) survive to hospital discharge.3 Brain injury related to cardiac arrest is a major determinant of mortality and disability.

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Mild hypothermia cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs

Cited by 311 publications

References 0 publications

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Abordagem do paciente reanimado, pós-parada cardiorrespiratória

Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation

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