2018
DOI: 10.3389/fneur.2018.00768
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Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest

Abstract: Out-of-hospital cardiac arrest (CA) remains a leading cause of sudden morbidity and mortality; however, outcomes have continued to improve in the era of targeted temperature management (TTM). In this review, we highlight the clinical use of TTM, and provide an updated summary of multimodality monitoring possible in a modern ICU. TTM is neuroprotective for survivors of CA by inhibiting multiple pathophysiologic processes caused by anoxic brain injury, with a final common pathway of neuronal death. Current guide… Show more

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Cited by 11 publications
(5 citation statements)
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References 125 publications
(173 reference statements)
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“…Of these 420 patients, 331 (78.8%) had a primary neurological diagnosis. These diagnoses included traumatic brain injury (57), brain tumor (54), seizures/status epilepticus (46), hydrocephalus/increased ICP (35), ischemic or hemorrhagic stroke (29), epilepsy surgery (25), meningitis/encephalitis (23), out-of-hospital cardiac arrest or drowning (14), spinal cord injury or lesion (12), other postoperative neurosurgery (30), and other medical neurological diagnoses (6). Furthermore, of the 420 patients who received neuroimaging or neuromonitoring, 89 (21.2%) had a primary non-neurological diagnosis.…”
Section: Resultsmentioning
confidence: 99%
See 1 more Smart Citation
“…Of these 420 patients, 331 (78.8%) had a primary neurological diagnosis. These diagnoses included traumatic brain injury (57), brain tumor (54), seizures/status epilepticus (46), hydrocephalus/increased ICP (35), ischemic or hemorrhagic stroke (29), epilepsy surgery (25), meningitis/encephalitis (23), out-of-hospital cardiac arrest or drowning (14), spinal cord injury or lesion (12), other postoperative neurosurgery (30), and other medical neurological diagnoses (6). Furthermore, of the 420 patients who received neuroimaging or neuromonitoring, 89 (21.2%) had a primary non-neurological diagnosis.…”
Section: Resultsmentioning
confidence: 99%
“…Frameworks for clinical practice using multimodal monitoring and physiologic goal-directed treatment are becoming more prevalent in adult brain injury and might improve neurologic outcomes [ 10 ]. Some clinical guidance and thresholds exist for neuromonitoring technologies in adult populations, such as cerebral near-infrared spectroscopy (NIRS), transcranial doppler (TCD), and electroencephalogram (EEG) in post-cardiac arrest and extracorporeal membrane oxygenation (ECMO) [ 11 , 12 , 13 ]. Similarly, neuromonitoring has noted benefits in anesthesia for certain intraoperative settings [ 14 ].…”
Section: Introductionmentioning
confidence: 99%
“…Lastly, shivering, which is a side effect of hypothermia, must be managed adequately to avoid temperature rise. The patient should therefore be sedated and paralyzed to reduce its undesirable effects (Leong et al, 2017; Nguyen et al, 2018).…”
Section: Thermoregulatory Mechanisms In Pathological Conditionsmentioning
confidence: 99%
“…To date, the diagnosis and evaluation of global cerebral I/R injury have mainly relied on clinical symptoms, neuroimaging, electrophysiology, and biochemical examination of blood or cerebrospinal fluid. However, hemodynamic instability, sedation, and hypothermia are common in these patients, limiting the application of these tests (Nguyen et al 2018 ). The main clinical treatment methods include supportive therapy, symptomatic treatment, mild hypothermia, and hyperbaric oxygen therapy.…”
Section: Introductionmentioning
confidence: 99%