15 research outputs found
Therapeutic hypothermia after cardiac arrest: implementation and outcome in Finnish intensive care units
Mild Therapeutic Hypothermia After Out-Of-Hospital Cardiac Arrest Complicating ST-Elevation Myocardial Infarction: Long-term Results in Clinical Practice
A critical and evidence based glance at some of the major publications in Critical Care in 2011
Effect of a pharmacologically induced decrease in core temperature in rats resuscitated from cardiac arrest
AIM: Hypothermia is recommended by international guidelines for treatment of unconscious survivors of cardiac arrest to improve neurologic outcomes. However, temperature management is often underutilized because it may be difficult to implement. The present study evaluated the efficacy of pharmacologically induced hypothermia on survival and neurological outcome in rats resuscitated from cardiac arrest. METHODS: Cardiac arrest was induced for 10 minutes in 120 rats. Sixty-one rats were resuscitated and randomized to normothermia, physical cooling or pharmacological hypothermia 5 minutes after resuscitation. Pharmacological hypothermia rats received a combination of ethanol, vasopressin and lidocaine (HBN-1). Physical hypothermia rats were cooled with intravenous iced saline and cooling pads. Rats in the pharmacological hypothermia group received HBN-1 at ambient temperature (20°C). Normothermic rats were maintained at 37.3 ± 0.2°C. RESULTS: HBN-1 (p<0.0001) shortened the time (85 ± 71 minutes) to target temperature (33.5°C) versus physical hypothermia (247 ± 142 minutes). The duration of hypothermia was 17.0 ± 6.8 hours in the HBN-1 group and 17.3 ± 7.5 hours in the physical hypothermia group (p=0.918). Survival (p=0.034), neurological deficit scores (p<0.0001) and Morris Water Maze performance after resuscitation (p=0.041) was improved in the HBN-1 versus the normothermic group. HBN-1 improved survival and early neurological outcome compared to the physical hypothermia group while there was no significant difference in performance in the Morris water maze. CONCLUSION: HBN-1 induced rapid and prolonged hypothermia improved survival with good neurological outcomes after cardiac arrest suggesting that pharmacologically-induced regulated hypothermia may provide a practical alternative to physical cooling
Therapeutic hypothermia: is it effective for non-VF/VT cardiac arrest?
Since 2003, therapeutic hypothermia (TH) is recommended for all comatose survivors after cardiac arrest (CA) due to VF/VT. However, only 25\u201330 % of CA patients have VF/VT as the initial recorded cardiac rhythm, and this percentage has further decreased in recent years. The benefit of TH for non-VF/VT CA are controversial.
Methods: Meta-analysis. All studies evaluating the benefit of TH in adult comatose survivors from CA were included. No limitations of study design, publication date and publication status were imposed.
Resuts: Two randomised trials and 15 observational studies were identified. Neither of the randomised trials was specifically designed to assess the benefit of TH in this patient population.TH-treated patients had a higher 6-mo survival rate than controls (5/22 vs. 2/22; risk ratio [RR] for mortality 0.85 [0.65\u20131.11] p = 0.24). Results of the 15 observational studies (12 reporting survival to discharge on 1,581 patients, and 13 reporting neurological outcome on 1,998 patients) showed that TH was associated to a significant reduction in the RR for both hospital mortality (0.88 [0.82\u20130.95]) and poor neurological outcome (0.95 [0.90\u20130.99]). However, several studies suggested no effect or possible harm from TH.
Conclusions: in patients resuscitated from non-VF/VT CA, use of TH is associated with a significant decrease in both hospital mortality and neurological outcome. Observed heterogeneity in study results may be explained by differences in case mix or cooling protocols and the presence of uncontrolled confounders, being most of the studies observational