Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention*

Wolfrum, Sebastian; Pierau, Christian; Radke, Peter W.; Schunkert, Heribert; Kurowski, Volkhard

doi:10.1097/ccm.0b013e31817437ca

Cited by 197 publications

(128 citation statements)

References 29 publications

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“…Bolesnik je odmah preveden u salu za kateterizaciju radi primarne perkutane koronarne intervencije (pPCI). Na koronaro- Medicinski fakultet Univerziteta u Beogradu, Beograd, Srbija, 3 Odeljenje interventne kardiologije, Kliničko-bolnički Centar Zvezdara, Beograd, Srbija, 4 Medicinski fakultet Univerziteta u Kragujevcu, Kragujevac, Srbija Najčešći uzrok srčanog zastoja u vanbolničkim uslovima je koronarna bolest, a najvažniji prediktori preživljavanja su oštećenje mozga i kardiovaskularni status. Prikazan je slučaj bolesnika starog 52 godine, primljenog u Koronarnu jedinicu (KJ) u postreanimacionoj komi nakon srčanog zastoja u vanbolničkim uslovima, a u okviru akutnog infarkta miokarda (AIM).…”

Section: Prikaz Slučajaunclassified

“…4 Stopa preživljavanja kod ovih bolesnika i dalje je veoma niska. 5 Kod najvećeg broja bolesnika postoje kritične stenoze ili akutne okluzije koronarnih arterija i zato je jedan od najvažnijih ciljeva lečenja što brže uspostavljanje adekvatne reperfuzije i normalizacija hemodinamskog stanja Teorijski, bolesnici koji su preživeli srčani zastoj u vanbolničkim uslovima lečeni pPCI, imaju istu prognozu kao i drugi bolesnici sa AIM lečeni ovom vrstom reperfuzione terapije.…”

Section: Diskusijaunclassified

“…primarne PCI Slika 2. Postupak i oprema za sprovođenje terapijske hipotermije su mozak, pluća i dr. 4,6 Prema rezultatima nekoliko velikih studija, upotreba terapijske hipotermije može da dovede do značajnog smanjenja mortaliteta i poboljšanja neurološkog ishoda kod ovih bolesnika. 1,7 Internacionalni komitet za resuscitaciju (ILCOR) je 2003. godine usvojio preporuke za primenu terapijske hipotermije kod bolesnika u postreanimacionoj komi nakon uspešne resuscitacije kada je inicijalni ritam bio ventrikularna fibrilacija.…”

Section: Diskusijaunclassified

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Therapeutic hypothermia and primary percutaneous coronary intervention in comatose survivor of out-of-hospital cardiac arrest due to acute myocardial infarction

Ušćumlić¹,

Radosavljevic-Radovanovic²,

Ašanin³

et al. 2012

Srce i krvni sudovi

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Uvod Srčani zastoj u vanbolničkim uslovima je glavni uzrok neočekivane smrti u razvijenim zemljama, sa stopom preživljavanja od 5 % do 35%.1 Iako je za preživljavanje ovih bolesnika od najvećeg značaja pravovremeno preduzeta kardiopulmonalna resuscitacija, terapijske procedure primenjene nakon uspostavljana srčanog rada i spontane cirkulacije, kao što je terapijska hipotermija, mogu značajno da smanje mortalitet i poboljšaju funkcionalni neurološki ishod.2 Sigurnost i efikasnost terapijske hipotermije ispitane su u brojnim kliničkim studijama koje su pokazale veoma dobre rezultate, zbog čega se ova procedura sve više uvodi kao nova terapijska mera u cilju smanjenja posledica hipoksične povrede mozga nakon srčanog zastoja.3 Najče-šći uzrok srčanog zastoja u vanbolničkim uslovima je koronarna bolest, a najvažniji prediktori preživljavanja ovih bolesnika su oštećenje mozga i kardiovaskularni status. Prikaz slučajaBolesnik star 52 godine primljen je u Koronarnu jedinicu (KJ) KCS u postreanimacionoj komi nakon srčanog zastoja u vanbolničkim uslovima, a u okviru akutnog infarkta miokarda (AIM) inferoposterolateralne lokalizacije. Tokom prethodne noći iz sna ga je probudio jak bol u grudima, zbog čega se obratio službi Hitne pomoći koja je postavila dijagnozu, ordinirala dvojnu antitrombocitnu terapiju i transportovala bolesnika u salu za kateterizaciju srca KCS. Tokom transporta kod bolesnika dolazi do srča-nog zastoja, monitorski se registruje asistolija, te su započete mere kardiopulmonalne resuscitacije koje su nastavljene u ambulanti reanimacije Urgentnog centra. Registrovana je ventrikularna fibrilacija, bolesnik je defibrilisan i nakon 15 minuta od srčanog zastoja uspostavljena je srčana radnja i spontana cirkulacija. U stanju postreanimacione kome bolesnik je primljen u KJ, intubiran, veštački ventiliran, acijanotičan i afebrilan. U objektivnom nalazu nad plućima se registruje normalan disajni šum, na srcu pravilan ritam, vrednost krvnog pritiska iznosila je 100/50 mmHg, a srčane frekvence 130/min. Fizikalni nalaz abdomena i na ekstremitetima je bio bez osobenosti. EKG pri prijemu je pokazao ST elevaciju u inferolateralnim odvodima uz ST depresiju u odvodima V1-V4. Bolesnik je odmah preveden u salu za kateterizaciju radi primarne perkutane koronarne intervencije (pPCI). Na koronaroTerapijska hipotermija i primarna perkutana koronarna intervencija kod bolesnika u postreanimacionoj komi nakon srčanog zastoja u akutnom infarktu miokarda Medicinski fakultet Univerziteta u Kragujevcu, Kragujevac, Srbija Najčešći uzrok srčanog zastoja u vanbolničkim uslovima je koronarna bolest, a najvažniji prediktori preživljavanja su oštećenje mozga i kardiovaskularni status. Prikazan je slučaj bolesnika starog 52 godine, primljenog u Koronarnu jedinicu (KJ) u postreanimacionoj komi nakon srčanog zastoja u vanbolničkim uslovima, a u okviru akutnog infarkta miokarda (AIM). Nakon uspostavljanja spontane cirkulacije bolesnik je, uz odgovarajuću medikamentnu pripremu, upućen u salu za kateterizaciju srca KCS, gde je urađena aspiracija...

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Section: Prikaz Slučajaunclassified

Section: Diskusijaunclassified

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Therapeutic hypothermia and primary percutaneous coronary intervention in comatose survivor of out-of-hospital cardiac arrest due to acute myocardial infarction

Ušćumlić¹,

Radosavljevic-Radovanovic²,

Ašanin³

et al. 2012

Srce i krvni sudovi

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show abstract

“…Da jedoch sowohl Thoraxschmerz als auch ST-Veränderungen bei den Patienten nach Kreislaufstillstand nur eingeschränkt korrekt einen akuten koronaren Verschluss voraussagen [660], soll bei allen Patienten nach Kreislaufstillstand, bei denen eine KHK angenommen werden kann, eine PCI in Erwägung gezogen werden [630,634,660,661,662,663,664,665,666]. Mehrere Studien weisen darauf hin, dass bei einem Patienten mit einem Kreislaufstillstand, der aufgrund eines ACS aufgetreten ist, die Kombination von Hypothermie und PCI machbar sowie sicher ist [630,634,639,666,667].…”

Section: Herz-kreislauf-systemunclassified

Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)

Deakin

Nolan

Soar

et al. 2010

Notfall Rettungsmed

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“…Early coronary angiography with subsequent PCI should be recommended for primary resuscitated cardiacarrested patients suspected to have myocardial infarction or severe coronary heart disease [34][35][36] (GOE IV, V). MTH can be initiated and maintained during coronary angiography and PCI 34,63 (GOE IV) Pre-or in-hospital thrombolysis is recommended for patients with ST elevation if there are no facilities for immediate PCI. Other causes of arrest, both of cardiac and non-cardiac aetiology, should also be diagnosed and receive specific treatment, if possible.…”

Section: Timing Of Other Interventionsmentioning

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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Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention*

Cited by 197 publications

References 29 publications

Therapeutic hypothermia and primary percutaneous coronary intervention in comatose survivor of out-of-hospital cardiac arrest due to acute myocardial infarction

Therapeutic hypothermia and primary percutaneous coronary intervention in comatose survivor of out-of-hospital cardiac arrest due to acute myocardial infarction

Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)

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

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