Temperature control after cardiac arrest: friend or foe

Nolan, Jerry P.; Soar, Jasmeet

doi:10.1097/mcc.0000000000000943

Cited by 4 publications

(2 citation statements)

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“…The lack of clear diagnostic criteria and indications in these cases may be responsible for the fact that TH is not offered to infants with postnatal events in many centers. The current trend toward targeted temperature management to maintain normothermia and avoid fever rather than initiation and maintenance of hypothermia in resuscitated adults may also influence neonatologists' attitudes toward TH in post partum events ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic hypothermia for encephalopathic newborns with congenital heart defect: A cross-sectional survey on current practices and opinions in Germany

Boos

Berger

2022

Front. Pediatr.

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BackgroundTherapeutic hypothermia (TH) reduces neonatal mortality and long-term neurodevelopmental impairment in infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) caused by perinatal asphyxia. There is an increasing trend to apply TH in other indications and populations, such as infants with mild HIE or neonates with congenital heart defects (CHD), even though there is little evidence to support or refute this.ObjectiveThe aim of this survey was to analyze practice variations with respect to TH use in neonates with CHD and to assess expert opinions on this topic across tertiary neonatal departments in Germany.Methods/DesignA web-based survey was sent to all tertiary neonatal departments in Germany. The questionnaire contained 32 multiple-choice questions. The survey inquired current practices on TH in newborns with CHD and expert opinions on various clinical scenarios.Main resultsA total 80 (51.3%) neonatal departments partially completed the survey, and 69 (44.2%) respondents filled out the whole questionnaire. All 80 (100.0%) departments perform TH. TH is offered by 76 (95.0%) respondents to encephalopathic newborns with simple CHD. In infants with critical/complex CHD, TH is offered after perinatal asphyxial HIE and in newborns with encephalopathy after severe acidosis associated with cardiac complications by 25 (31.3%), or 17 (22.1%) respondents, respectively, whereas a clear majority of centers reject TH in these infants. Unclear effects of TH on any ongoing prostaglandin therapy (57.6 and 52.3%, respectively), an increased risk for adverse reactions during TH (51.6 and 52.3%, respectively) and lack of evidence (33.3 and 53.8%, respectively) are the most frequently cited reasons for not performing TH in these infants. The majority of experts from neonatal departments providing comprehensive care for neonates with severe CHD support the initiation of TH in encephalopathic neonates.DiscussionThe considerable heterogeneity in the use of TH in neonates with CHD emphasizes the need for further research to optimize treatment strategies for these patients.

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Section: Discussionmentioning

confidence: 99%

Therapeutic hypothermia for encephalopathic newborns with congenital heart defect: A cross-sectional survey on current practices and opinions in Germany

Boos

Berger

2022

Front. Pediatr.

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“…Indeed, EEG could be sensitive to hypothermia, inducing a decrease of the amplitude and frequency of the EEG background (around 33 °C), a burst suppression (between 33 and 31 °C) or an isoelectric pattern (at 22 °C) [79]. These different levels of hypothermia remain lower than those currently recommended for TTM management [24,80]. Furthermore, temperature management at 36 °C does not lead to significant EEG change [31].…”

Section: Eeg Prognostic Value According To Sedation Hypothermia and T...mentioning

confidence: 99%

Prognostication after cardiac arrest: how EEG and evoked potentials may improve the challenge

Benghanem

Pruvost-Robieux

Bouchereau

et al. 2022

Ann. Intensive Care

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About 80% of patients resuscitated from CA are comatose at ICU admission and nearly 50% of survivors are still unawake at 72 h. Predicting neurological outcome of these patients is important to provide correct information to patient’s relatives, avoid disproportionate care in patients with irreversible hypoxic–ischemic brain injury (HIBI) and inappropriate withdrawal of care in patients with a possible favorable neurological recovery. ERC/ESICM 2021 algorithm allows a classification as “poor outcome likely” in 32%, the outcome remaining “indeterminate” in 68%. The crucial question is to know how we could improve the assessment of both unfavorable but also favorable outcome prediction. Neurophysiological tests, i.e., electroencephalography (EEG) and evoked-potentials (EPs) are a non-invasive bedside investigations. The EEG is the record of brain electrical fields, characterized by a high temporal resolution but a low spatial resolution. EEG is largely available, and represented the most widely tool use in recent survey examining current neuro-prognostication practices. The severity of HIBI is correlated with the predominant frequency and background continuity of EEG leading to “highly malignant” patterns as suppression or burst suppression in the most severe HIBI. EPs differ from EEG signals as they are stimulus induced and represent the summated activities of large populations of neurons firing in synchrony, requiring the average of numerous stimulations. Different EPs (i.e., somato sensory EPs (SSEPs), brainstem auditory EPs (BAEPs), middle latency auditory EPs (MLAEPs) and long latency event-related potentials (ERPs) with mismatch negativity (MMN) and P300 responses) can be assessed in ICU, with different brain generators and prognostic values. In the present review, we summarize EEG and EPs signal generators, recording modalities, interpretation and prognostic values of these different neurophysiological tools. Finally, we assess the perspective for futures neurophysiological investigations, aiming to reduce prognostic uncertainty in comatose and disorders of consciousness (DoC) patients after CA.

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Effects of temperature control on hyperthermia-related cardiac dysfunction in a porcine model of cardiac arrest

et al. 2023

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Temperature control after cardiac arrest: friend or foe

Cited by 4 publications

References 40 publications

Therapeutic hypothermia for encephalopathic newborns with congenital heart defect: A cross-sectional survey on current practices and opinions in Germany

Therapeutic hypothermia for encephalopathic newborns with congenital heart defect: A cross-sectional survey on current practices and opinions in Germany

Prognostication after cardiac arrest: how EEG and evoked potentials may improve the challenge

Effects of temperature control on hyperthermia-related cardiac dysfunction in a porcine model of cardiac arrest

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