Outcome of Survivors of Accidental Deep Hypothermia and Circulatory Arrest Treated with Extracorporeal Blood Warming

Walpoth, B.; Bn, Walpoth-Aslan; Mattle, HP; Radanov, Bogdan P.; Schroth, Gerhard; Schaeffler, Leonard; Ap, Fischer; Segesser, L. von; Althaus, U

doi:10.1056/nejm199711203372103

Cited by 399 publications

(246 citation statements)

References 37 publications

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“…In cats and monkeys, resuscitation has been achieved after 1 hr of complete circulatory arrest, although delayed lesions occur in vulnerable brain regions (3,4). In humans, cardiac arrests of prolonged durations are tolerated in conditions of hypothermia, whether it is accidental (38) or controlled during cardiac surgery (39). However, in normothermic conditions, successful cardiac resuscitation is not obtained when circulatory arrest lasts more than a few minutes.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest in rodents: Maximal duration compatible with a recovery of neuronal activity

Charpak

Audinat

1998

Proc. Natl. Acad. Sci. U.S.A.

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We report here that during a permanent cardiac arrest, rodent brain tissue is ''physiologically'' preserved in situ in a particular quiescent state. This state is characterized by the absence of electrical activity and by a critical period of 5-6 hr during which brain tissue can be reactivated upon restoration of a simple energy (glucose͞oxygen) supply. In rat brain slices prepared 1-6 hr after cardiac arrest and maintained in vitro for several hours, cells with normal morphological features, intrinsic membrane properties, and spontaneous synaptic activity were recorded from various brain regions. In addition to functional membrane channels, these neurons expressed mRNA, as revealed by single-cell reverse transcription-PCR, and could synthesize proteins de novo. Slices prepared after longer delays did not recover. In a guinea pig isolated whole-brain preparation that was cannulated and perfused with oxygenated saline 1-2 hr after cardiac arrest, cell activity and functional long-range synaptic connections could be restored although the electroencephalogram remained isoelectric. Perfusion of the isolated brain with the ␥-aminobutyric acid A receptor antagonist picrotoxin, however, could induce self-sustained temporal lobe epilepsy. Thus, in rodents, the duration of cardiac arrest compatible with a short-term recovery of neuronal activity is much longer than previously expected. The analysis of the parameters that regulate this duration may bring new insights into the prevention of postischemic damages.Cardiac arrest lasting a few seconds to a couple of minutes can be reversed without brain damage upon cardiopulmonary resuscitation. After cardiac arrests lasting longer, however, reperfusion of the brain is accompanied by delayed irreversible brain damage that occurs several days after reperfusion of the tissue (for reviews, see refs. 1 and 2). The postischemic period during which neuronal activity recovers but which precedes the appearance of delayed damage is particularly important because it constitutes a therapeutic window in which to prevent delayed cell death. In animal models of global normothermic ischemia, it has been shown that this postischemic period occurs even after a complete interruption of cerebral blood flow lasting up to 1 hr (3-6). Our purpose here was to evaluate the maximal duration of cardiac arrest compatible with the occurrence of this postischemic period. The early phase of the period was analyzed in acute brain tissue prepared after a cardiac arrest of several hours and maintained in vitro.Criteria characterizing acute tissue health in vitro are not clearly established (7). However, the association of normal electrophysiological and morphological parameters with the presence of undegraded mRNAs and the ability of the in vitro tissue to synthesize proteins should constitute an ensemble of signs representative of good health. Furthermore, the evolution of these parameters as a function of the delay between cardiac arrest and brain tissue reoxygenation should reflect the ability of t...

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Section: Discussionmentioning

confidence: 99%

Cardiac arrest in rodents: Maximal duration compatible with a recovery of neuronal activity

Charpak

Audinat

1998

Proc. Natl. Acad. Sci. U.S.A.

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“…Prinzipiell gilt bei hypothermer Reanimation der Grundsatz: "Nobody is dead until rewarmed and dead". Dies gilt deshalb, weil die Hypothermie den zellulären Sauerstoffbedarf derart reduziert, dass auch Patienten mit prolongierter Kreislaufinsuffizienz nach Wiedererwärmung prinzipiell eine gute Prognose haben [36]. So konnte 1999 eine 28-jährige Frau im hypothermen Kreislaufstillstand bei 13,7°C mithilfe der extrakorporalen Zirkulation erfolgreich reanimiert werden [11].…”

Section: Introductionunclassified

“…Im Fall eines akuten Nierenversagens kann außerdem eine Hämofiltra-tionseinheit zwischengeschaltet werden. Bezüglich des Outcomes werden Überle-bensraten von bis zu 72,7% berichtet[35]; die neurologischen Ergebnisse sind in beinahe allen Fällen günstig[36]. Neben dem kardiopulmonalen Bypass stehen bei Patienten mit erhaltenem Kreislauf arteriovenöse[9] und venovenöse[1] extrakorporale Verfahren zur Verfügung, die allerdings bisher nur im Rahmen kleiner Fallserien evaluiert und in der Praxis von untergeordneter Bedeutung sind.Insgesamt stützen sich die Empfehlungen imBereich der Hypothermietherapie auf wenig klinische Daten.…”

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Management der akzidentellen Hypothermie

Hohlrieder¹,

Kaufmann²,

Moritz³

et al. 2007

Anaesthesist

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Patients with hypothermia are frequently encountered in emergency medicine. Particularly trauma patients, but also other predisposed persons, can be expected to suffer from hypothermia at any time of the year. Therapy focuses not only on symptom-oriented intensive care to stabilize and secure vital functions, but also on rewarming. Even in cases of severe hypothermia with circulatory arrest, therapy can produce excellent results. This paper first gives a brief overview of the typical clinical symptoms of hypothermia, before giving a detailed description of the preclinical and in-hospital management of the hypothermia patient. The various rewarming strategies are the subject of special attention and critical evaluation.

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“…Adrenalin und Vasopressin steigern im hypothermen Tiermodell (KKT<28°C) mit Kammerflimmern sowohl die koronare Perfussion [22,23] als auch die Wahrscheinlichkeit einer erfolgreichen Defibrillation [38,39] [25,45].…”

Section: Tab 4 Maßnahmen Zur Präklinischen Behandlung Der Hypothermieunclassified

Der Lawinennotfall

2006

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In North America and Europe around 140 persons die every year due to avalanches, approximately 35 in North America, 100 in the European Alps, and 5 in other parts of Europe. Most of the victims are skiers and snowboarders. This article outlines the specific pathophysiology of avalanche burials, such as hypoxia, hypercapnia, and hypothermia and also other factors which influence survival. Strategies to minimize the mortality due to avalanches and the on-site treatment of buried persons are discussed. Finally, possibilities to reduce the number of avalanche deaths are pointed out.

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Outcome of Survivors of Accidental Deep Hypothermia and Circulatory Arrest Treated with Extracorporeal Blood Warming

Abstract: This clinical experience demonstrates that young, otherwise healthy people can survive accidental deep hypothermia with no or minimal cerebral impairment, even with prolonged circulatory arrest. Cardiopulmonary bypass appears to be an efficacious rewarming technique.

Cited by 399 publications

References 37 publications

Cardiac arrest in rodents: Maximal duration compatible with a recovery of neuronal activity

Cardiac arrest in rodents: Maximal duration compatible with a recovery of neuronal activity

Management der akzidentellen Hypothermie

Der Lawinennotfall

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