Hypothermia Post Cardiac Arrest Research Articles

Hypothermia After Cardiac Arrest in Large Animals (HACA-LA): Study protocol of a randomized controlled experimental trial

BackgroundInduced hypothermia post-cardiac arrest is neuroprotective in animal experiments, but few high-quality studies have been performed in larger animals with human-like brains. The neuroprotective effect of postischemic hypothermia has recently been questioned in human trials. Our aim is to investigate whether hypothermia post-cardiac arrest confers a benefit compared to normothermia in large adult animals. Our hypothesis is that induced hypothermia post cardiac arrest is neuroprotective and that the effect diminishes when delayed two hours. MethodsAdult female pigs were anesthetized, mechanically ventilated and kept at baseline parameters including normothermia (38 °C). All animals were subjected to ten minutes of cardiac arrest (no-flow) by induced ventricular fibrillation, followed by four minutes of cardiopulmonary resuscitation with mechanical compressions, prior to the first countershock. Animals with sustained return of spontaneous circulation (systolic blood pressure >60 mmHg for ten minutes) within fifteen minutes from start of life support were included and randomized to three groups; immediate or delayed (2 h) intravenous cooling, both targeting 33 °C, or intravenously controlled normothermia (38 °C). Temperature control was applied for thirty hours including cooling time, temperature at target and controlled rewarming (0.5 °C/h). Animals were extubated and kept alive for seven days. The primary outcome measure is histological brain injury on day seven. Secondary outcomes include neurological and neurocognitive recovery, and the trajectory of biomarkers of brain injury. ConclusionHigh-quality animal experiments in clinically relevant large animal models are necessary to close the gap of knowledge regarding neuroprotective effects of induced hypothermia after cardiac arrest.Trial registration:Preclinicaltrials.eu (PCTE0000272), published 2021-11-03.

Brain Trust

Brain Trust

Minimal EEG montage with high yield for the detection of status epilepticus in the setting of postanoxic brain damage.

For the diagnosis of electrographic seizures or status epilepticus, we reduced the number of EEG-electrodes to make urgent EEG monitoring more feasible. Unlike the current existing research, with mixed results, we studied a specific population with postanoxic brain damage, expecting a higher yield of detection of ictal EEG patterns. In a population treated with therapeutic hypothermia post-cardiac arrest, the initial EEGs were reformatted in a longitudinal, a hairline and an 8-lead montage, and independently reviewed by two investigators. The EEGs were categorized into three categories: one without ictal EEG activity, one with interictal activity and one with probable electrographic seizure(s). Generalized ictal EEG activity was the most frequently observed EEG pattern. The average sensitivity for the detection of probable electrographic seizure(s) was 100% for the 8-lead montage and 92% in the hairline montage. In comparison to the routine longitudinal montage, the 8-lead montage proved to be reliable for the detection of electrographic seizure activity in a postanoxic population even with limited training in EEG interpretation. The hairline montage did not suffice with regard to the differential diagnosis of triphasic waves associated with metabolic encephalopathy and generalized nonconvulsive status epilepticus, but nonetheless detected the vast majority of probable electrographic seizure(s). Our results support the use of EEG monitoring with fewer electrodes for the detection of ictal EEG activity in the postanoxic population.

Abstract 17460: Anemia and Therapeutic Hypothermia Post-cardiac Arrest: Is There a Transfusion Threshold?

Introduction: Profound anemia has been shown to have deleterious effects in critically ill patients (pts). Currently, no data exists regarding the effects of anemia on outcomes in pts post-cardiac arrest treated with therapeutic hypothermia (TH). We aim to evaluate whether a correlation between anemia and neurologic outcome exists in this high risk population. Methods: We performed a retrospective study of 260 consecutive comatose survivors of cardiac arrest treated with TH. Independent variables included hematocrit at time of admission, 24, 48 and 72 hrs post-admission as well as packed red blood cell transfusions. The outcome variable was Cerebral Performance Category (CPC) score at discharge. CPC scores 1-2 represented good neurologic outcomes while scores 3-5 represented poor outcomes. A Spearman correlation was computed between each of the above independent variables and discharge CPC, adjusting for the following risk factors: place of arrest, arrest rhythm, time to ROSC, witnessed arrest and presence of chronic kidney disease. Results: Of 260 pts, 101 (38.9%) had a good neurologic outcome (CPC≤2) at discharge. The mean hematocrit at admission for males and females was 40 ± 6.4 and 39.2 ±7 % respectively. The Spearman coefficient between hematocrit and CPC score at discharge was not statistically significant (Figure 1). Coefficient for hematocrit at admission and 72hrs with CPC score at discharge was 0.07 (p = 0.32) and 0.01 (p = 0.85) respectively. Coefficient for transfusions and CPC score was -0.11 (p =0.1). Conclusion: Our data suggest that neurological outcomes after cardiac arrest in pts treated with TH are unrelated to hematocrit levels or transfusions. Based on these findings, conservative transfusion strategies may be appropriate in this patient population.

EEG monitoring in patients with hypothermia post cardiac arrest - a comparison of 'evolving' patterns and outcomes (P7.178)

EEG monitoring in patients with hypothermia post cardiac arrest - a comparison of 'evolving' patterns and outcomes (P7.178)

The use of therapeutic magnesium for neuroprotection during global cerebral ischemia associated with cardiac arrest and cardiac bypass surgery in adults: a systematic review protocol

The use of therapeutic magnesium for neuroprotection during global cerebral ischemia associated with cardiac arrest and cardiac bypass surgery in adults: a systematic review protocol

Evolving Patterns on Prolonged EEG Monitoring in Patients with Therapeutic Hypothermia Post-Cardiac Arrest (P1.270)

Evolving Patterns on Prolonged EEG Monitoring in Patients with Therapeutic Hypothermia Post-Cardiac Arrest (P1.270)

Endovascular hypothermia after cardiac arrest in a Chilean ICU

For more than a decade, mild hypothermia has been a standard for enhancing the neurological prognosis in comatose survivors of cardiac arrest (CA). Despite this, in our country there are still few centers that apply hypothermia post CA regularly. We describe a Chilean experience with endovascular hypothermia post CA, in three ICUs of the same university clinical center [1-3].

Therapeutic hypothermia post cardiac arrest: Evidence from a tertiary centre in the North West of England

Purpose of the study: Cardiac disease is the most common cause of mortality in Western countries, with most deaths due to out-of-hospital cardiac arrest (OHCA). Over the last 10 years survival has significantly improved, especially when presenting with ventricular fibrillation (VF) as initial rhythm. The reasons are undoubtedly multi-factorial, but seem to coincide with the use of therapeutic hypothermia (TH) following OHCA. Indeed, the European Resuscitation Council (ERC) has extended its use to include both, shockable and non-shockable rhythms in their 2010 guidelines. We designed this study in view of investigating our performance in TH post OHCA, focusing on initiation, delivery and survival to hospital discharge and at 28-days post OHCA.

Survey on the management of patients treated with therapeutic hypothermia post cardiac arrest in London hospitals

The second UK national survey on therapeutic hypothermia (TH) post cardiac arrest demonstrated an impressive increase in its implementation across the UK (from 28% to 85.6%) [1]. Therapeutic hypothermia, however, induces numerous physiological and pathophysiological changes and therefore should be performed in a standardised and controlled manner in order to be safe and effective. We carried out a telephone survey to determine the current TH practice in London hospitals.

Effects of variation in temperature management on cerebral performance category scores in patients who received therapeutic hypothermia post cardiac arrest

AimTo assess differences in cerebral performance category (CPC) in patients who received therapeutic hypothermia post cardiac arrest by time to initiation, time to target temperature, and duration of therapeutic hypothermia (TH). MethodsA secondary data analysis was conducted using hospital-specific data from the international cardiac arrest registry (INTCAR) database. The analytic sample included 172 adult patients who experienced an out-of-hospital cardiac arrest and were treated in one Midwestern hospital. Measures included time from arrest to ROSC, arrest to TH, arrest to target temperature, and length of time target temperature was maintained. CPC was assessed at three points: transfer from ICU, discharge from hospital, and post discharge follow-up. ResultsAverage age was 63.6 years and 74.4% of subjects were male. Subjects had TH initiation a mean of 94.4min (SD 81.6) after cardiac arrest and reached target temperature after 309.0min (SD 151.0). In adjusted models, the odds of a poor neurological outcome increased with each 5min delay in initiating TH at transfer from ICU (OR=1.06, 95% C.I. 1.02–1.10). Similar results were seen for neurological outcomes at hospital discharge (OR=1.06, 95% C.I. 1.02–1.11) and post-discharge follow-up (OR=1.08, 95% C.I. 1.03–1.13). Additionally the odds of a poor neurological outcome increased for every 30min delay in time to target temperature at post-discharge follow-up (OR=1.17, 95% C.I. 1.01–1.36). ConclusionIn adults undergoing TH post cardiac arrest, delay in initiation of TH and reaching target temperature differentiated poor versus good neurologic outcomes. Randomized trials assessing the range of current recommended guidelines for TH should be conducted to establish optimal treatment protocols.

Implementation of Therapeutic Hypothermia Post-Cardiac Arrest in the Community Hospital Settin

PURPOSE: Based on the landmark studies from Australia and Europe, survival rates for out of hospital cardiac arrest improved to 49 to 59 % with favorable neurologic outcomes when therapeutic hypothermia was introduced. Despite these favorable results, and recommendations to use Therapeutic Hypothermia in the 2005 American Heart Association ACLS Guidelines, adoption of Targeted Temperature Management for out of hospital cardiac arrest has been slow. There are multiple perceived barriers to implementation at Community Hospitals.

Implementation of Therapeutic Hypothermia After Cardiac Arrest in the Intensive Care Unit

Sudden cardiac death is the most common cause of death in the United States. Despite aggressive resuscitation, only one tenth to one third of successfully resuscitated patients survive to lead an independent life. Although evidence clearly supports the use of induced therapeutic hypothermia post–cardiac arrest, the precise data on how to best implement this process is still forthcoming. Protocol-based treatment regimens have been shown to improve morbidity and mortality of patients with common ICU illnesses. This article discusses the multiple elements compromising therapeutic hypothermia and presents recommendations for a protocol-driven regimen that can be implemented across varied critical care settings.

Use of the Medicool™ cooling system to increase efficacy of therapeutic hypothermia post cardiac arrest

Use of the Medicool™ cooling system to increase efficacy of therapeutic hypothermia post cardiac arrest

Regionalized Care for Time‐critical Conditions: Lessons Learned From Existing Networks

The 2010 Academic Emergency Medicine (AEM) consensus conference "Beyond Regionalization" aimed to place the design of a 21st century emergency care delivery system at the center of emergency medicine's (EM's) health policy research agenda. To examine the lessons learned from existing regional systems, consensus conference organizers convened a panel discussion made up of experts from the fields of acute care surgery, interventional cardiology, acute ischemic stroke, cardiac arrest, critical care medicine, pediatric EM, and medical toxicology. The organizers asked that each member provide insight into the barriers that slowed network creation and the solutions that allowed them to overcome barriers. For ST-segment elevation myocardial infarction (STEMI) management, the American Heart Association's (AHA's) Mission: Lifeline aims to increase compliance with existing guidelines through improvements in the chain of survival, including emergency medical services (EMS) protocols. Increasing use of therapeutic hypothermia post-cardiac arrest through a network of hospitals in Virginia has led to dramatic improvements in outcome. A regionalized network of acute stroke management in Cincinnati was discussed, in addition to the effect of pediatric referral centers on pediatric capabilities of surrounding facilities. The growing importance of telemedicine to a variety of emergencies, including trauma and critical care, was presented. Finally, the importance of establishing a robust reimbursement mechanism was illustrated by the threatened closure of poison control centers nationwide. The panel discussion added valuable insight into the possibilities of maximizing patient outcomes through regionalized systems of emergency care. A primary challenge remaining is for EM to help to integrate the existing and developing disease-based systems of care into a more comprehensive emergency care system.

Survey of the use of therapeutic hypothermia post cardiac arrest

ObjectivesTherapeutic hypothermia improves neurological outcome in adults after ventricular fibrillation cardiac arrest and neonates with hypoxic ischaemic encephalopathy. There is currently no clinical research to support its use in the...

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Strategies for improving post arrest care: The S.P.A.R.C. hypothermia project

Introduction: To design and apply a knowledge translation (KT) program to improve the use of the 2005 AHA guideline on hypothermia post cardiac arrest in 100% of eligible out of hospital cardiac arrest patients.

Controlled Therapeutic Hypothermia Post-Cardiac Arrest Compared with Standard Intensive Care Unit Therapy

Controlled Therapeutic Hypothermia Post-Cardiac Arrest Compared with Standard Intensive Care Unit Therapy

Therapeutic hypothermia post cardiac arrest: an evidence-based guideline

Recent studies have shown that induced hypothermia improves neurologic outcome in comatose survivors of cardiac arrest (CA). Our goal was to develop, implement and evaluate an evidence-based guideline for the management of comatose survivors of cardiac arrest.