Cardiac index during therapeutic hypothermia: which target value is optimal?

Raphaël Giraud,Karim Bendjelid,Nils Siegenthaler

doi:10.1186/cc12523

Raphaël Giraud, Karim Bendjelid + Show 1 more

Open Access

https://doi.org/10.1186/cc12523

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Journal: Critical Care	Publication Date: Mar 19, 2013
Citations: 26	License type: cc-by

Affiliation: University Hospital of Geneva

Abstract

Mild therapeutic hypothermia is now recognized as standard therapy in patients resuscitated from out-of-hospital cardiac arrest (OHCA), and is recommended in comatose patients suffering from cardiac arrest related to ventricular fibrillation (VF) [1]. In these patients, maintaining an adequate tissue oxygen delivery (DO2) is crucial. However, during hypothermia, clinical signs of hypoperfusion such as cold, clammy skin and delayed capillary refill are not reliable and monitoring devices must, therefore, be used to measure or estimate the cardiac index (CI). However, there are no recommendations regarding the target value of CI in the hypothermic patient. In this article, the authors attempt to provide clinicians with some rationale to guide their therapy for the management of CI in patients treated with mild therapeutic hypothermia.

Highlights

Mild therapeutic hypothermia is recognized as standard therapy in patients resuscitated from out-ofhospital cardiac arrest (OHCA), and is recommended in comatose patients suffering from cardiac arrest related to ventricular fibrillation (VF) [1]
Clinical data demonstrate that heart rate is significantly reduced, an effect that usually improves left ventricular (LV) filling [4]
Whereas cardiac index (CI) usually decreases with hypothermia, mild therapeutic hypothermia exerts positive inotropic effects in isolated human and pig myocardium

Summary

Introduction

Mild therapeutic hypothermia is recognized as standard therapy in patients resuscitated from out-ofhospital cardiac arrest (OHCA), and is recommended in comatose patients suffering from cardiac arrest related to ventricular fibrillation (VF) [1]. Clinical data demonstrate that heart rate is significantly reduced, an effect that usually improves left ventricular (LV) filling [4]. In the temperature range recommended for mild therapeutic hypothermia in cardiac arrest patients (32– 34 °C) [11,12], diastolic function seems to be preserved [6].

Results

Conclusion