Therapeutic hypothermia after cardiac arrest in clinical practice: Review and compilation of recent experiences

Sagalyn, Emily B.; Band, Roger A.; Gaieski, David F.; Abella, Benjamin S.

doi:10.1097/ccm.0b013e3181aa5c7c

Cited by 95 publications

(41 citation statements)

References 28 publications

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“…rate coma in patients with acute neurologic injury: by decreasing metabolic demand during a period of cell stress, it might increase cell survival to improve long-term outcome (319,432,604).…”

Section: Are Electrically Active Tissues Other Than Skeletal Muscle Amentioning

confidence: 99%

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Friedrich

Reid

Berghe

et al. 2015

Physiological Reviews

300

329

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Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss. Reduced membrane excitability results from depolarization and ion channel dysfunction. Mitochondrial dysfunction contributes to energy-dependent processes. Ubiquitin proteasome and calpain activation trigger muscle proteolysis and atrophy while protein synthesis is impaired. Myosin loss is more pronounced than actin loss in CIM. Protein quality control is altered by inadequate autophagy. Ca 2ϩ dysregulation is present through altered Ca 2ϩ homeostasis. We highlight clinical hallmarks, trigger factors, and potential mechanisms from human studies and animal models that allow separation of risk factors that may trigger distinct mechanisms contributing to weakness. During critical illness, altered inflammatory (cytokines) and metabolic pathways deteriorate muscle function. ICUAW prevention/treatment is limited, e.g., tight glycemic control, delaying nutrition, and early mobilization. Future challenges include identification of primary/secondary events during the time course of critical illness, the interplay between membrane excitability, bioenergetic failure and differential proteolysis, and finding new therapeutic targets by help of tailored animal models.

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Section: Are Electrically Active Tissues Other Than Skeletal Muscle Amentioning

confidence: 99%

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Friedrich

Reid

Berghe

et al. 2015

Physiological Reviews

300

329

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“…There was concern about adverse complications related to hypothermia. 45 Staff equated anoxic time before CPR, duration of CPR, cause of the arrest, low early score on the Glasgow Coma Scale, and presence of myoclonus as predictors of poor outcomes and reasons to not pursue aggressive postarrest care. Finally, on a national level, high morbidity and mortality rates with this postarrest population contributed to providers' reluctance to intervene with PCI in comatose patients immediately after cardiac arrest.…”

Section: Barriers To Implementationmentioning

confidence: 99%

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

Williams

Calder²,

Cocchi³

et al. 2013

Critical Care Nurse

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Out-of-hospital cardiac arrest remains common and, despite advances in resuscitation practices, continues to carry a high mortality that may be influenced by several factors, including where a patient is cared for after the cardiac arrest. Implementing a post–cardiac arrest care guideline for survivors of out-of-hospital and in-hospital cardiac arrest involves a multidisciplinary approach with short-term and long-term strategies. Physician and nursing leaders must work in synergy to guide the implementation of an evidence-based plan of care. A collaborative approach was used at a hospital to develop processes, build consensus for protocols, and provide support to staff and teams. A joint approach has allowed the hospital to move from traditional silos of individual departmental care to a continuum of patient-focused management after cardiac arrest. This care coordination is initiated in the emergency department and follows the patient through to discharge.

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“…Although varied in their protocols and outcome reporting, results from published investigations confirmed the findings from the landmark randomized controlled trials, in that the use of therapeutic hypothermia increased survival and favorable neurologic outcome. [42] …”

Section: Antithrombotic Rolementioning

confidence: 99%