Ischemic Cardiac Arrest Research Articles

Abstract 12447: Early Coronary Reperfusion Improves Cerebral and Systemic Hemodynamics After Ischemic Refractory Cardiac Arrest and Extracorporeal Resuscitation in Pigs

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is widely proposed for the treatment of refractory cardiac arrest. It should be associated to etiologic determination, especially if acute coronary artery occlusion is suspected. However, prioritization of care remains unclear in this situation. Hypothesis: Our goal was to determine whether reperfusion should be instituted as soon as possible during ischemic refractory cardiac arrest treated by extracorporeal cardiopulmonary resuscitation (ECPR) in pigs. Methods: Pigs were instrumented and submitted to coronary artery occlusion prior to ventricular fibrillation. After 5 min of untreated cardiac arrest, life support was started using external chest compression (ECC) during 15 min followed by ECPR during 240 min, respectively. Animals randomly underwent either early or late coronary reperfusion after 20 or 120 min of ECPR, respectively. Return of spontaneous circulation (ROSC) was determined as organized ECG rhythm with systolic blood pressure above 80 mmHg. Results: Hemodynamic parameters were not different between groups at baseline or during ECC. Since the onset of ECPR, carotid blood flow was improved by ≈70% vs ECC in both groups. No animal (0/7) elicited ROSC after late reperfusion vs 4/7 after early reperfusion (p<0.05). Hemodynamic parameters, such as mean arterial pressure and carotid blood flow, were improved in early vs late reperfusion groups (Figure), along with infarct size decrease (71±4 vs 84±2 % of the risk zone, respectively; p<0.05). Conclusions: Early reperfusion improved hemodynamic status and increased ROSC chances after ischemic refractory cardiac arrest treated by ECPR. This supports the need of rapid reperfusion in this situation. Figure: Carotid blood flow after extracorporeal cardiopulmonary resuscitation (ECPR) and successful defibrillation (*, p<0.05 between groups; comparisons were only made at the end of the follow-up).

Trend of deaths due to circulatory system in Erbil City between 2007 to 2011

Background: Circulatory diseases are one of the leading causes of death in the world which continue to rise despite preventive measures.Objective: To determine gender, age and cause specific trends of mortality due to circulatory diseases between 2007 and 2011 in Erbil city.Methods: A review of registered death records from disease of circulatory system was performed at the statistical unit in Directorate of Health in Erbil city. No special codes for the cause of death were available on death certificate. Statistical analysis was done using SPSS version 19Results: Diseases of circulatory system was responsible for 25.5% of total deaths during the study period. Highest rates were recorded at 2011 with 74 deaths per100000 population. After 2009, circulatory mortality increased sharply to be the first cause of death till 2011, Stroke, Ischemic heart diseases (IHD), cardiac arrest and heart failure were the main cause of deaths. Most of deaths occur in age group of 65-74 years. Ischemic heart diseases was the main cause of death in male (31.5%) while stroke in female (34.5%) which were statistically significantConclusion: Circulatory mortality was the second leading cause of death in Erbil city till the year 2009 where it started to increase to be the first cause till 2011. Future preventive public health strategies for circulatory diseases prevention are mandatory.

Investigating the Effects of Mild Induced Hypothermia on Cognition using a Measure of Sustained Attention

Mild Induced hypothermia has come to be recognised as a successful method of providing neuro-protective treatment for patients suffering ischemic stroke, cardiac arrest and traumatic brain injury (TBI). Anti-inflammatory responses and the lowering of cerebral metabolic rates, leading to a reduction in neuronal apoptosis, are considered to be the main mechanisms by which this process benefits patients. Assessment of a new hydro based cooling device, which could potentially be used by emergency service units, provided the impetus for the current research. Neurologically normal participants underwent two treatments: a cooling procedure where the temperature of water circulating in a cooling helmet was maintained at 4∘C and a non-cooling/sham procedure where the temperature was set at 18∘C. During treatment participants were required to perform a computer-based task that measured sustained attention/vigilance via participant response times during target detection. Electroencephalographic (EEG) recordings were also acquired before and after each treatment condition. Participants' core temperature (recorded via tympanic membrane) was monitored throughout the process. The findings revealed a statistically reliable 0.62 ∘C decrease in temperature as a result of cooling after controlling for participants' body mass index (BMI). However, there were no reliable cognitive or EEG spectral changes induced by the decrease in temperature.

Inability to Consent Does not Diminish the Desirability of Stroke Thrombolysis: Chiong W, Kim AS, Huang IA, et al. Ann Neurol 2014;76:296−304.

Recently, the American Academy of Neurology and the American Heart Association/American Stroke Association have endorsed the use of thrombolysis in incapacitated persons without surrogate decision makers. The rationale for this position is that a reasonable person would consent to treatment if asked. The goal of this study was to evaluate the influence of the inability to consent and of personal health-related values on older adults’ emergency treatment preferences for both ischemic stroke and cardiac arrest.

16 Effect of Therapeutic Hypothermia on Regional and Transmural Ventricular Fibrillation Waveform Complexity in a Model of Ischemic Cardiac Arrest

16 Effect of Therapeutic Hypothermia on Regional and Transmural Ventricular Fibrillation Waveform Complexity in a Model of Ischemic Cardiac Arrest

Inability to consent does not diminish the desirability of stroke thrombolysis.

Some have argued that physicians should not presume to make thrombolysis decisions for incapacitated patients with acute ischemic stroke because the risks and benefits of thrombolysis involve deeply personal values. We evaluated the influence of the inability to consent and of personal health-related values on older adults' emergency treatment preferences for both ischemic stroke and cardiac arrest. A total of 2,154 US adults age ≥50 years read vignettes in which they had either suffered an acute ischemic stroke and could be treated with thrombolysis, or had suffered a sudden cardiac arrest and could be treated with cardiopulmonary resuscitation. Participants were then asked (1) whether they would want the intervention, or (2) whether they would want to be given the intervention even if their informed consent could not be obtained. We elicited health-related values as predictors of these judgments. Older adults were as likely to want stroke thrombolysis when unable to consent (78.1%) as when asked directly (76.2%), whereas older adults were more likely to want cardiopulmonary resuscitation when unable to consent (83.6% compared to 75.9%). Greater confidence in the medical system and reliance on statistical information in decision making were both associated with desiring thrombolysis. Older adults regard thrombolysis no less favorably when considering a situation in which they are unable to consent. These findings provide empirical support for recent professional society recommendations to treat ischemic stroke with thrombolysis in appropriate emergency circumstances under a presumption of consent.

Erythropoietin: Powerful protection of ischemic and post-ischemic brain

Ischemic brain injury inflicted by stroke and cardiac arrest ranks among the leading causes of death and long-term disability in the United States. The brain consumes large amounts of metabolic substrates and oxygen to sustain its energy requirements. Consequently, the brain is exquisitely sensitive to interruptions in its blood supply, and suffers irreversible damage after 10-15 min of severe ischemia. Effective treatments to protect the brain from stroke and cardiac arrest have proven elusive, due to the complexities of the injury cascades ignited by ischemia and reperfusion. Although recombinant tissue plasminogen activator and therapeutic hypothermia have proven efficacious for stroke and cardiac arrest, respectively, these treatments are constrained by narrow therapeutic windows, potentially detrimental side-effects and the limited availability of hypothermia equipment. Mounting evidence demonstrates the cytokine hormone erythropoietin (EPO) to be a powerful neuroprotective agent and a potential adjuvant to established therapies. Classically, EPO originating primarily in the kidneys promotes erythrocyte production by suppressing apoptosis of proerythroid progenitors in bone marrow. However, the brain is capable of producing EPO, and EPO's membrane receptors and signaling components also are expressed in neurons and astrocytes. EPO activates signaling cascades that increase the brain's resistance to ischemia-reperfusion stress by stabilizing mitochondrial membranes, limiting formation of reactive oxygen and nitrogen intermediates, and suppressing pro-inflammatory cytokine production and neutrophil infiltration. Collectively, these mechanisms preserve functional brain tissue and, thus, improve neurocognitive recovery from brain ischemia. This article reviews the mechanisms mediating EPO-induced brain protection, critiques the clinical utility of exogenous EPO to preserve brain threatened by ischemic stroke and cardiac arrest, and discusses the prospects for induction of EPO production within the brain by the intermediary metabolite, pyruvate.

Survival with good neurological outcome in a patient with prolonged ischemic cardiac arrest—Utility of automated chest compression systems in the cardiac catheterization laboratory

The management of refractory cardiac arrest during invasive coronary procedures has substantial logistical challenges and is typically associated with disappointing outcomes. We describe the case of a young woman with recalcitrant ventricular fibrillation due to acute anterior ST-elevation myocardial infarction caused by occlusion of her proximal left anterior descending artery. Survival without neurological deficit or organ failure was achieved following primary percutaneous reperfusion and a total of 52 min of intra-procedural chest compression support, made possible by the use of an automated chest compression device.

Abstract 85: Development of a Readily Translatable Model of Resuscitation From Ischemic Cardiac Arrest to Assess Regional and Global Arrhythmia Substrates and Outcomes

Background: Little is known about the effect of therapeutic hypothermia (TH) on arrhythmias in the resuscitated heart. TH has a beneficial effect on defibrillation thresholds and ROSC. However, there are no studies investigating why TH might be anti-arrhythmic during resuscitation from ischemia-induced cardiac arrest, the most common clinical scenario. Our goal was to develop a novel translational porcine model of resuscitation from regional ischemia-induced VF with the ability to identify differences in both regional and global arrhythmia substrates in order to determine mechanisms of the antiarrhythmic effect of TH and improve outcomes. Methods: Pigs underwent anesthesia and thoracotomy, and a large LAD occlusion was made. VF was induced after 30 min if spontaneous VF did not occur. CPR was started after 8 min with defibrillation and cardiac massage to achieve ROSC. Infarct was continued for a total of 60 min then reperfusion was continued for 60 min. Electrograms (EG) were recorded from multipolar needle (transmural) plunge electrodes at multiple sites and monophasic action potential (MAP) recordings were used to determine transmural and regional heterogeneities of repolarization and conduction. All spontaneous arrhythmias were recorded. Outcomes were compared between control (temp 37oC, CT), Pre-ischemia TH (TH 33oC), and post-infarct TH (TH-infarct). Cooling was induced using a cooling blanket, cold saline IV infusion, and ice packs. Results: Hemodynamic parameters were recorded during ischemia, during CPR, and reperfusion. Appropriate CPR was verified by BP and CO2 monitoring. 2/4 animals survived to the end of protocol in the CT group, 4/5 in the TH group, and 0/2 in the TH-infarct group. Total ROSC time was 9.8±7 for CT vs 37.5±6 (p<.04) for TH group (no ROSC for TH-infarct). EG’s were used to assess activation recovery intervals at transmural sites in the infarct, noninfarct, and border zones. Regional VF waveforms were obtained. Conclusions: We developed a translatable model of resuscitation from ischemic cardiac arrest using regional and global electrophysiologic monitoring to assess arrhythmia substrates. These data suggest improved outcomes during resuscitation with TH.

Early coronary revascularization improves 24 h survival and neurological function after ischemic cardiac arrest. A randomized animal study

BackgroundSurvival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24h-survival and neurological outcomes. MethodsTotal occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5min, VF was induced and left untreated for 8min. If return of spontaneous circulation (ROSC) was achieved within 15min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45min (group A) or 4h (group B) of LAD occlusion. Animals without ROSC after 15min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion. ResultsEarly compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p=0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0.005) and CK-MB (11±4 versus 20.1±5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C. ConclusionsEarly reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.

Predictors of sudden death after 12-year follow-up in acute coronary syndrome (from the ABC study on acute coronary syndrome)

animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45 minutes (group A) or 4 hours (group B) of LAD occlusion. Animals without ROSC after 15 minutes of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45 minutes of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10 minutes of CPR had been performed. Primary endpoints for groups A and B were 24-hour survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion. Results: Early compared to late reperfusion improved survival (10/11 versus 4/10, p= 0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p= 0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0,005) and CK-MB (11±4 versus 20.1±5, p=0.031) at 24-hr after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C. Conclusions: Early reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.

Abstract TP432: Glyco-proteomic Study of Therapeutic Hypothermia in Global Ischemic Brain Injury Post Cardiac Arrest

Background: Global ischemic brain injury post cardiac arrest is prevalent with dismal prognosis -- less than 10% survive to hospital discharge. Therapeutic hypothermia (TH) is an efficacious neuroprotective treatment, protects against multi-organ damage, doubles the chance of good neurologic outcome and decreases mortality by 25%, but is grossly underutilized (<5%). We use a glyco-proteomic approach to better understand and predict TH response, because: 1) glycosylation is one of the most important and common extracellular post-translational modifications in immunity and coagulation, and is crucial in TH-related side effects such as sepsis and bleeding; 2) it occurs rapidly over the time window of treatment; and 3) it can be used to focus proteomic profiling by targeting specific plasma signals. Methods: Lectin array and various lectin immunoblots were used to study plasma glycosylation patterns of TH patients (n=30; 24 hrs post cardiac arrest) with good vs poor clinical outcome (evaluated at 3 months post event). To identify and enrich candidate plasma proteins with potential clinical utility, specific lectin affinity chromatography and LC-MS/MS were performed. Results: Plasma glycosylation patterns differ dramatically with respect to clinical outcome in TH-treated patients. On screening lectin blots (figure), whereas SBA showed little change, RCA (decreased around 35-100kD - in box) and ConA (increased around 40-150kD - in box) were different in a wide range of MW, and WGA identified unique banding around 100kD (in box) in TH responders. In lectin affinity pull-down, more than 400 specific glycoproteins were identified showing significant changes with respect to TH outcome. Conclusion: A glyco-proteomic approach is promising to help predict neurologic outcome, select TH responders, and triage hypothermic therapy in global ischemic brain injury patients post cardiac arrest. Further studies are under way to investigate these exploratory findings.

Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in a Sheep Model of Refractory Ischaemic Cardiac Arrest

Survival after out-of-hospital cardiac arrest remains limited. It is therefore imperative to develop new resuscitation techniques. We aimed to determine the potential role of extracorporeal membrane oxygenation assisted CPR (ECPR) in an animal model of refractory ischaemic cardiac arrest. Twelve sheep were assigned to either ECPR (n=6) or 'conventional' (n=6) resuscitation. All sheep had coronary occlusion, followed by induction of ventricular fibrillation (VF). CPR was than commenced for 10 min in both groups, followed by randomisation to ECPR or CPR for a further 10 min. At 23 min post induction of VF, advanced life support measures were commenced with direct cardioversion, adrenaline and amiodarone. Outcomes measures included rates of return of spontaneous circulation (ROSC), and analysis of VF wave form. Baseline haemodynamics were similar between the two groups. CPR consistently produced coronary perfusion pressures (CPP) greater than 15 mmHg in both groups, with significantly increased CPP post commencement of ECMO in the ECPR group (17.84±2 mmHg vs 22.94±3 mmHg, p=0.04). Number of shocks, pH, lactate and oxygenation were also comparable. Significantly greater rates of ROSC were seen in the ECPR sheep, 3/6 (50%) vs 0/6 (0%) (p=0.032), which was also associated with significantly increased VF amplitude measures (0.51±0.08 mV vs 0.42±0.06 mV, p=0.04). This study indicates that ECPR increases return of circulation and coronary perfusion pressure in a sheep model of ischaemic VF arrest. Our findings have supported the development of a pilot trial into the effectiveness and feasibility of ECPR in the clinical setting.

Abstract 74: Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in a Sheep Model of Refractory Ischemic Cardiac Arrest

Background: Survival after cardiac arrest in the field remains limited. It is therefore imperative to develop new resuscitation techniques. We aimed to determine the potential role of extracorporeal membrane oxygenation assisted CPR (ECPR) in an animal model of refractory ischemic cardiac arrest. Methods: Twelve sheep were assigned to either ECPR (n = 6) or ‘conventional’ (n = 6) resuscitation. All sheep had coronary occlusion, followed by induction of ventricular fibrillation. CPR was than commenced for 10 minutes in both groups, followed by randomisation to ECPR or CPR for a further 10 minutes. At 23 minutes post induction of VF, advanced life support measures were commenced with direct cardioversion, adrenaline and amiodarone. Outcomes measures included rates of return of spontaneous circulation (ROSC), and analysis of VF wave form. Results: Baseline hemodynamics were similar between the two groups. CPR consistently produced coronary perfusion pressures (CPP) greater than 15mmHg in both groups, with significantly increased CPP post commencement of ECMO in the ECPR group (17.8 4+/-2mmHg vs 22.94+/-3mmHg, p=0.04). Number of shocks, pH, lactate and oxygenation were also comparable. Significantly greater rates of ROSC were seen in the ECPR sheep, 3/6 (50%) vs 0/6 (0%) (p=0.032), which was also associated with significantly increased VF amplitude measures (0.51+/-0.02Mv vs 0.42+/-0.04Mv, p=0.04). Conclusions: This study indicates that ECPR provides a valuable adjunct to the management of patients with refractory VF arrest. Our findings have supported the development of a pilot trial into the effectiveness and feasibility of ECPR in the clinical setting.

Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in a Sheep Model of Refractory Ischaemic Cardiac Arrest

Background: Survival after cardiac arrest in the field remains limited. It is therefore imperative to develop new resuscitation techniques. We aimed to determine the potential role of extracorporeal membrane oxygenation assisted CPR (ECPR) in an animal model of refractory ischemic cardiac arrest. Methods: Twelve sheep were assigned to either ECPR (n = 6) or ‘conventional’ (n = 6) resuscitation. All sheep had coronary occlusion, followed by induction of ventricular fibrillation. CPR was than commenced for 10 min in both groups, followed by randomisation to ECPR or CPR for a further 10 min. At 23 min post induction of VF, advanced life support measures were commenced with direct cardioversion, adrenaline and amiodarone. Outcomes measures included rates of return of spontaneous circulation (ROSC), and analysis of VF wave form. Results: Baseline haemodynamics were similar between the two groups. CPR consistently produced coronary perfusion pressures (CPP) greater than 15 mmHg in both groups, with significantly increased CPP post commencement of ECMO in the ECPR group (17.84 ± 2 mmHg vs 22.94 ± 3 mmHg, p = 0.04). Number of shocks, pH, lactate and oxygenation were also comparable. Significantly greater rates of ROSC were seen in the ECPR sheep, 3/6 (50%) vs 0/6 (0%) (p = 0.032), which was also associated with significantly increased VF amplitude measures (0.51 ± 0.02Mv vs 0.42 ± 0.04Mv, p = 0.04). Conclusions: This study indicates that ECPR provides a valuable adjunct to the management of patients with refractory VF arrest. Our findings have supported the development of a pilot trial into the effectiveness and feasibility of ECPR in the clinical setting.

Predictors of resuscitation in a swine model of ischemic and nonischemic ventricular fibrillation cardiac arrest: Superiority of amplitude spectral area and slope to predict a return of spontaneous circulation when resuscitation efforts are prolonged*

We have demonstrated that a return of spontaneous circulation in the first 3 mins of resuscitation in swine is predicted by ventricular fibrillation waveform (amplitude spectral area or slope) when untreated ventricular fibrillation duration or presence of acute myocardial infarction is unknown. We hypothesized that in prolonged resuscitation efforts that return of spontaneous circulation immediately after a second or later shock with postshock chest compression is independently predicted by end-tidal CO2, coronary perfusion pressure, and ventricular fibrillation waveform measured before that shock in a swine model of ischemic and nonischemic ventricular fibrillation arrest. Animal intervention study with comparison to a control group. University animal laboratory. Twenty swine. Myocardial infarction was induced by steel plug occlusion of the left anterior descending coronary artery. Ventricular fibrillation was untreated for 8 mins in normal swine (n=10) and acute myocardial infarction swine (n=10). End-tidal CO2, coronary perfusion pressure, and ventricular fibrillation waveform characteristics of amplitude spectral area and slope were analyzed before second or later shocks. For an amplitude spectral area>35 mV-Hz, the odds ratio for achieving return of spontaneous circulation after that shock was 72 (95% confidence interval, 3.8-1300; p=.004) compared with an amplitude spectral area<28 mV-Hz and with an area under the receiver operator characteristic curve of 0.86. For slope>3.6 mV/s, the odds ratio for achieving return of spontaneous circulation was 36 (95% confidence interval, 2.7-480; p=.007) compared with slope<2.72 mV/s with an area under the curve of 0.86. End-tidal CO2 and coronary perfusion pressure were not predictive of return of spontaneous circulation after a shock, although coronary perfusion pressure was significantly related to both amplitude spectral area (p<.001) and slope (p<.001). : In prolonged untreated ventricular fibrillation arrest, the waveform characteristics of amplitude spectral area and slope predict the attainment of return of spontaneous circulation with a second or later shock. This has implications for the ideal means to customize the timing of shocks and chest compressions when return of spontaneous circulation is not promptly obtained.

Randomised comparison of percutaneous left ventricular assist device with open-chest cardiac massage and with surgical assist device during ischaemic cardiac arrest

Aims A percutaneous left ventricular assist device can maintain blood flow to vital organs during ventricular fibrillation and may improve outcomes in ischaemic cardiac arrest. We compared haemodynamic and clinical effects of a percutaneous left ventricular assist device with a larger device deployed via endovascular prosthesis and with open-chest cardiac massage during ischaemic cardiac arrest. Methods Eighteen swine were randomised into three groups. After thoracotomy, coronary ischaemia and ventricular fibrillation was induced. Cardiac output was measured with transit-time flowmetry. Tissue perfusion was measured with microspheres. Defibrillation was performed after 20 min. Results Cardiac output with cardiac massage was 1129 mL min −1 vs. 1169 mL min −1 with the percutaneous- and 570 mL min −1 with the surgical device ( P < 0.05 surgical vs. others). End-tidal CO 2 was 3.3 kPa with cardiac massage vs. 3.2 kPa with the percutaneous- and 2.3 kPa with the surgical device ( P < 0.05 surgical vs. others). Subepicardial perfusion was 0.33 mL min −1 g −1 with cardiac massage vs. 0.62 mL min −1 g −1 with both devices ( P < 0.05 devices vs. massage), cerebral perfusion was comparable between groups (all reported values after 3 min cardiac arrest, all P < 0.05 vs. baseline, all P = NS for 3 min vs. 15 min). Return of spontaneous circulation was achieved in 5/6 subjects with cardiac massage vs. 6/6 with the percutaneous- and 4/6 with the surgical device ( P = NS). Conclusion The percutaneous device improved myocardial perfusion, maintained cerebral perfusion and systemic circulation with similar rates of successful defibrillation vs. cardiac massage. Increased delivery was not obtained with the surgical device during cardiac arrest.

Exposure to metal welding fume particles and risk for cardiovascular disease in Denmark: a prospective cohort study

ObjectivesTo study welding fume particles in relation to cardiovascular diseases.MethodsIn 1986, 10 059 male metal workers in 75 welding companies were sent a questionnaire about their welding experience and lifestyle...

Hyperthermia and fever control in brain injury

Fever in the neurocritical care setting is common and has a negative impact on outcome of all disease types. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest has a negative impact on morbidity and mortality. Data support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. Recent advances have made eliminating fever and maintaining normothermia feasible. However, there are no prospective randomized trials demonstrating the benefit of fever control in these patient populations, and important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential risks of prolonged fever control.

Fever control in the neuro-ICU: why, who, and when?

Fever in the neurocritical care setting is very common and has a negative impact on outcome of all disease types. Recent advances have made eliminating fever and maintaining normothermia feasible. However, important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest have a negative impact on morbidity and mortality. There are data to support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. However, there are currently no prospective randomized trials demonstrating the benefit of fever control in these patient populations. The negative impact of fever after neurologic injury is well understood. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential infectious risk of prolonged fever control.