Neurological Outcome In Comatose Survivors Research Articles

Enhanced analysis of somatosensory evoked potentials at 20–30 milliseconds can predict neurological outcome after cardiac arrest

ObjectiveThis study attempted to test the effectiveness of an enhanced analysis of the 20–30 ms complex of somatosensory evoked potentials, in predicting the short-term outcome of comatose survivors of out of hospital cardiac arrest and compare it with the current clinical practice. MethodsSingle-centre, prospective, observational study. Median nerve SSEP recording performed at 24–36 h post-return of spontaneous circulation. Recording was analysed using amplitude measurements of P25/30 and Peak-To-Trough of 20–30 ms complex and thresholds to decide P25/30 presence. Neurological outcome was dichotomised into favourable and unfavourable. Results89 participants were analysed. 43.8% had favourable and 56.2% unfavourable outcome. The sensitivity, specificity, positive and negative predictive values of the present SSEP and favourable outcome were calculated. P25/30 presence and size of PTT improved positive predictive value and specificity, while maintained similar negative predictive value and sensitivity, compared to the current practice. Inter-interpreter agreement was also improved. ConclusionsEnhanced analysis of the SSEP at 20–30 ms complex could improve the short-term prognostic accuracy for short-term neurological outcome in comatose survivors of cardiac arrest. SignificancePeak-To-Trough analysis of the 20–30 ms SSEP waveform appears to be the best predictor of neurological outcome following out of hospital cardiac arrest. It is also the easiest and most reliable to analyse.

Repolarization abnormalities and outcomes following return of spontaneous circulation after cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Boston Medical Center Background Prolongation of ventricular repolarization, as measured by the corrected QT interval (QTc), is common in patients resuscitated from cardiac arrest and is exacerbated by targeted temperature management. In this population, QTc prolongation appears to be transient and may not be associated with risk for malignant arrhythmia. The T-peak to T-end interval (TpTe), which represents transmural dispersion of repolarization in the left ventricle, is an emerging marker of risk for sudden cardiac death. Purpose We sought to evaluate the association of prolonged QTc and TpTe with in-hospital mortality and favorable neurologic outcome at discharge in comatose survivors of cardiac arrest. Methods We conducted a retrospective analysis of patients enrolled in the Multimodal Outcome CHAracterization in cardiac arrest patients (MOCHA) study at a single academic center. Participants were comatose survivors of cardiac arrest aged 18-89 years who had an electrocardiogram (ECG) obtained after return of spontaneous circulation between 2011-2020. Prolonged QTc was defined as QTc >450 ms in males and QTc >460 ms in females as measured by automated algorithm. Prolonged TpTe was defined as TpTe >90 ms as measured by two trained assessors. The primary outcomes were in-hospital mortality and favorable neurologic outcome at hospital discharge (Cerebral Performance Category 1-2). Multivariable logistic regression, adjusted for age, medical comorbidities (diabetes, chronic kidney disease, heart failure, malignancy) and arrest characteristics (location, initial rhythm, witnessed status, bystander CPR) was used to test the association between QTc prolongation and TpTe prolongation and outcomes. Results 471 (89.0%) patients met inclusion criteria and were included in this analysis; 58 (11.0%) were excluded due to missing post-ROSC ECG. The median age was 62 years (Interquartile range (IQR): 51-73 years), and 284 (60.4%) were male. 297 (63.2%) presented with out-of-hospital cardiac arrest and 138 (29.4%) presented with a shockable rhythm. The median QTc was 479 ms (IQR: 445-517 ms) and the median TpTe was 82.5 ms (IQR: 66-102 ms). Patients with and without prolonged QTc had similar incidence of mortality (71.2% vs 65.5%, P=0.22) and favorable neurologic outcome (22.4% vs 26.9%, P=0.29). Mortality was higher among patients with prolonged TpTe (75.4% vs 65.8%, P=0.03), which persisted after multivariable adjustment (OR 1.91; 95% CI: 1.20-3.04, P<0.01). Patients with prolonged TpTe had lower incidence of favorable neurologic outcome (18.3% vs 27.1%, P=0.03), which persisted after multivariable adjustment (OR 0.47; 95% CI: 0.28-0.79, P<0.01). Conclusion TpTe prolongation, but not QTc prolongation, was independently associated with higher mortality and worse neurologic outcome in comatose survivors of cardiac arrest. Further research is needed to clarify the clinical significance of repolarization abnormalities in patients presenting with cardiac arrest.

Abstract 225: Late Awakening In Comatose Survivors Of Out-of-hospital Cardiac Arrest

Background: Despite advanced neuroprognostication using neuron-specific enolase, electroencephalogram and brain imaging, prediction of neurological outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA) remain challenging and early discontinuation of postresuscitation treatment may be harmful for patients with delayed awakening. Hypothesis: Significant proportion of comatose survivors of OHCA may regain consciousness only after discharge from intensive care unit (ICU). Methods: Consecutive comatose survivors of OHCA admitted to our ICU between January 1, 2003 and December 31, 2021 were investigated. Cerebral performance category (CPC) was used for evaluation of neurological recovery. CPC 1 indicated complete recovery, CPC 2 mild neurological impairment, CPC 3 severe neurological impairment and CPC 4 vegetative state. Results: A total of 1098 patients (63 + 14 years, 79% (864 of 1098) men) were enrolled. OHCA was witnessed in 88% (966 of 1098), basic life support was performed in 57% 630 of 1098), delay to emergency team arrival was 7.5 + 5.3 minutes and initial shockable rhythm was present in 77%. (851 of 1098). Reestablishment of spontaneous circulation (ROSC) was obtained after 12.9 + 11.8 minutes of advanced life support. Coronary angiography was performed in 74% (822 of 1098) and percutaneous coronary intervention in 52% (567 of 1098). Mechanical circulatory support was used in 16% (175 of 1098) and hypothermia (32-34 C) in 85% (940 of 1098). Among 740 patients who survived to ICU discharge on day 7 (median), 272 patients (36.8%) of patients remained in CPC 3-4 ( Figure). Among these 272 patients, CPC 1-2 at hospital discharge was documented in 19.9%. (54 patients). Conclusion: Almost 20% of comatose survivors of OHCA without neurological recovery at ICU discharge may ultimately regain consciousness. This argues against premature withdrawal of care in step down units and normal wards.

Targeted temperature management after cardiac arrest : What is new?

The current guidelines of the European Resuscitation Council recommend targeted temperature management to improve functional neurological outcome in comatose survivors after cardiac arrest. With the pathophysiological background of hypothermia-induced neuroprotection for prevention of hypoxic-ischemic encephalopathy, targeted temperature management is akey measure and represents acentral aspect in postresuscitation care.In the 2021 guidelines the application of targeted temperature management in postresuscitation care has been recommended for all rhythms and irrespective of the location of cardiac arrest. Targeted temperature management is advocated for adult patients who remain unresponsive following return of spontaneous circulation (ROSC) after either out-of-hospital cardiac arrest or in-hospital cardiac arrest. The body temperature should be maintained at aconstant value between 32 °C and 36 °C for at least 24 h. To avoid rebound hyperthermia, fever following targeted temperature management, defined as atemperature above 37.7 °C, should be prevented and treated for at least 72 h after ROSC in persistently comatose patients. The routine use of prehospital cooling by rapid infusion of large volumes of cold i.v. fluid immediately after ROSC is not recommended.Based on asystematic review of the current literature, this article summarizes the results of randomized trials and new findings on targeted temperature management in comatose adult patients after cardiac arrest. The review has aparticular focus on the most recent evidence regarding the optimum range of target temperatures. Furthermore, recent data on preclinical management, different patient populations, the duration of targeted temperature management, cooling methods and rebound hyperthermia are discussed.The impact of targeted temperature management on neurological outcome after cardiac arrest has been amatter of controversy. Despite contradictory results and heterogeneity of study designs, the current evidence supports the relevance and the necessity of strict temperature control in postresuscitation care for neuroprotection and improvement in functional neurological outcomes.

Imaging for Neuroprognostication After Cardiac Arrest: Systematic Review and Meta-analysis.

Predicting neurological outcome in comatose survivors of cardiac arrest relies on clinical findings, radiological and neurophysiological test results. To evaluate the predictive accuracy of brain computed tomography (CT) and magnetic resonance imaging (MRI) for prognostication of neurological outcomes after cardiac arrest. We searched MEDLINE (database inception to August 2018) and included all observational cohort studies or randomized controlled trials including adult (16 years or older) survivors of cardiac arrest which evaluated the diagnostic accuracy of CT or MRI for predicting neurologic outcome or mortality. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. All review stages were conducted independently by 2 reviewers, and where possible data were pooled using bivariate meta-analysis. The main outcome was to evaluate the of accuracy of CT and MRI in neuroprognostication of patients after cardiac arrest. We included 44 studies that examined brain CT (n = 24) or MRI (n = 21) in 4008 (n per study, 9-398) patients. Decreased grey to white matter ratio on CT (20 studies) was useful for predicting poor neurological outcome (sensitivity 0.44, 95% CI 0.29-0.60; specificity 0.97, 95% CI 0.93-0.99; positive likelihood ratio [LR+] 13.8, 95% CI 6.9-27.7). Similarly, diffusion-weighted imaging (DWI) on MRI (16 studies; sensitivity 0.77, 95% CI 0.65-0.85; specificity 0.92, 95% CI 0.85-0.96; LR+ 9.2, 95% CI 5.2-16.4) and DWI and fluid-attenuated inversion recovery (FLAIR) MRI (4 studies, sensitivity 0.70, 95% CI 0.43-0.88; specificity 0.95, 95% CI 0.79-0.99; LR+ 13.4, 95% CI 3.5-51.2) were useful for predicting poor neurological outcomes. We found marked heterogeneity in timing of radiological examinations and neurological assessments relative to the cardiac arrest. Decreased grey to white matter ratio on CT and DWI or DWI and FLAIR on MRI are useful adjuncts for predicting poor early neurological outcome after cardiac arrest.

The neuron specific enolase (NSE) ratio offers benefits over absolute value thresholds in post-cardiac arrest coma prognosis

IntroductionSerum neuron-specific enolase (NSE) levels have been shown to correlate with neurologic outcome in comatose survivors of cardiac arrest but use of absolute NSE thresholds is limited. This study describes and evaluates a novel approach to analyzing NSE, the NSE ratio, and evaluates the prognostic utility of NSE absolute value thresholds and trends over time. Methods100 consecutive adult comatose cardiac arrest survivors were prospectively enrolled. NSE levels were assessed at 24, 48, and 72 h post-arrest. Primary outcome was the Glasgow Outcome Score (GOS) at 6 months post-arrest; good outcome was defined as GOS 3–5. Absolute and relative NSE values (i.e. the NSE ratio), peak values, and the trend in NSE over 72 h were analyzed. Results98 patients were included. 42 (43%) had a good outcome. Five good outcome patients had peak NSE >33 µg/L (34.9–46.4 µg/L). NSE trends between 24 and 48 h differed between outcome groups (decrease by 3.0 µg/L (0.9–7.0 µg/L) vs. increase by 13.4 µg/L (−3.7 to 69.4 µg/L), good vs. poor, p = 0.004). The 48:24 h NSE ratio differed between the good and poor outcome groups (0.8 (0.6–0.9) vs. 1.4 (0.8–2.5), p = 0.001), and a 48:24 h ratio of ≥1.7 was 100% specific for poor outcome. ConclusionsThe NSE ratio is a unique method to quantify NSE changes over time. Values greater than 1.0 indicate increasing NSE and may be reflective of ongoing neuronal injury. The NSE ratio obviates the need for an absolute value cut-off.

APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management.

BackgroundThis study assessed the association between the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score and good neurological outcome in comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management (TTM).MethodsData from survivors of cardiac arrest who received TTM between January 2011 and June 2016 were retrospectively analyzed. The initial APACHE II score was determined using the data immediately collected after return of spontaneous circulation rather than within 24 hours after being admitted to the intensive care unit. Good neurological outcome, defined as Cerebral Performance Category 1 or 2 on day 28, was the primary outcome of this study.ResultsAmong 143 survivors of cardiac arrest who received TTM, 62 (43.4%) survived, and 34 (23.8%) exhibited good neurological outcome on day 28. The initial APACHE II score was significantly lower in the patients with good neurological outcome than in those with poor neurological outcome (23.71 ± 4.39 vs. 27.62 ± 6.16, P = 0.001). The predictive ability of the initial APACHE II score for good neurological outcome, assessed using the area under the receiver operating characteristic curve, was 0.697 (95% confidence interval [CI], 0.599 to 0.795; P = 0.001). The initial APACHE II score was associated with good neurological outcome after adjusting for confounders (odds ratio, 0.878; 95% CI, 0.792 to 0.974; P = 0.014).ConclusionsIn the present study, the APACHE II score calculated in the immediate post-cardiac arrest period was associated with good neurological outcome. The initial APACHE II score might be useful for early identification of good neurological outcome.

The esophageal cooling device: A new temperature control tool in the intensivist's arsenal

BackgroundTherapeutic hypothermia has been demonstrated to improve neurological outcome in comatose survivors of cardiac arrest. Current temperature control modalities however, have several limitations. Exploring innovative methods of temperature management has become a necessity. MethodsWe describe the first use of a novel esophageal cooling device as a sole modality for hypothermia induction, maintenance and rewarming in a series of four postcardiac arrest patients. The device was inserted in a manner similar to standard orogastric tubes and connected to an external heat exchange unit. ResultsA mean cooling rate of 0.42 °C/hr (SD ± 0.26) was observed. An average of 4 hr 24 min (SD ± 2 hr 6 min) was required to reach target temperature, and this was maintained 90.25% (SD ± 16.20%) of the hypothermia protocol duration. No adverse events related to device use were encountered. Questionnaires administered to ICU nursing staff regarding ease-of-use of the device and its performance were rated as favorable. ConclusionsWhen used as a sole modality, objective performance parameters of the esophageal-cooling device were found to be comparable to standard temperature control methods. More research is required to further quantify efficacy, safety, assess utility in other patient populations, and examine patient outcomes with device use in comparison to standard temperature control modalities.

Advance in the study of prognostication of neurological outcome in comatose survivors from cardiac arrest

Early prognostication of neurological outcome in comatose survives after cardiopulmonary resuscitation, an essential component of post-cardiac arrest care is significantly meaningful in both clinical and economic fields. From the perspectives of predictors based on neurological examination, electroencephalogram, evoked potentials, neuroimaging and blood biomarkers and taking advantage of therapeutic hypothermia into consideration, this article reviews the development in evaluation of neurological outcome in comatose survives after cardiac arrest. Key words: Cardiac arrest; Coma; Outcome; Prognostication

36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.

36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.

Impact of Presenting Rhythm on Short- and Long-Term Neurologic Outcome in Comatose Survivors of Cardiac Arrest Treated With Therapeutic Hypothermia: Terman SW, Hume B, Meurer WJ, et al. Crit Care Med 2014;42:2225−34.

Impact of Presenting Rhythm on Short- and Long-Term Neurologic Outcome in Comatose Survivors of Cardiac Arrest Treated With Therapeutic Hypothermia: Terman SW, Hume B, Meurer WJ, et al. Crit Care Med 2014;42:2225−34.

Bradycardia during therapeutic hypothermia is associated with good neurologic outcome in comatose survivors of out-of-hospital cardiac arrest.

Comatose patients resuscitated after out-of-hospital cardiac arrest receive therapeutic hypothermia. Bradycardia is frequent during therapeutic hypothermia, but its impact on outcome remains unclear. We explore a possible association between bradycardia during therapeutic hypothermia and neurologic outcome in comatose survivors of out-of-hospital cardiac arrest. Retrospective cohort study, from January 2009 to January 2011. University hospital medical and cardiac ICUs. One hundred eleven consecutive comatose out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Patients treated with standardized treatment protocol after cardiac arrest. All out-of-hospital cardiac arrest patients' records were reviewed. Hemodynamic data were obtained every fourth hour during the first days. The patients were in temperature target range (32-34°C) 8 hours after out-of-hospital cardiac arrest and dichotomized into bradycardia and nonbradycardia groups depending on their actual heart rate less than or equal to 60 beats/min or more than 60 beats/min at that time. Primary endpoint was Cerebral Performance Category score at hospital discharge. More nonbradycardia group patients received epinephrine during resuscitation and epinephrine and norepinephrine in the early in-hospital period. They also had lower base excess at admission. Survival rate with favorable outcome was significantly higher in the bradycardia than the nonbradycardia group (60% vs 37%, respectively, p = 0.03). For further heart rate quantification, patients were divided into quartiles: less than or equal to 49 beats/min, 50-63 beats/min, 64-77 beats/min, and more than or equal to 78 beats/min, with respective proportions of patients with good outcome at discharge of 18 of 27 (67%), 14 of 25 (56%), 12 of 28 (43%), and 7 of 27 (26%) (p = 0.002). Patients in the lowest quartile had significantly better outcome than the higher groups (p = 0.027), whereas patients in the highest quartile had significantly worse outcome than the lower three groups (p = 0.013). Bradycardia during therapeutic hypothermia was associated with good neurologic outcome at hospital discharge. Our data indicate that bradycardia should not be aggressively treated in this period if mean arterial pressure, lactate clearance, and diuresis are maintained at acceptable levels. Studies, both experimental and clinical, are warranted.

Impact of presenting rhythm on short- and long-term neurologic outcome in comatose survivors of cardiac arrest treated with therapeutic hypothermia.

To compare short- and long-term neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest treated with mild therapeutic hypothermia presenting with nonshockable versus shockable initial rhythms. Retrospective cohort study. Emergency department and ICU of an academic hospital. One hundred twenty-three consecutive post-out-of-hospital cardiac arrest adults (57 nonshockable rhythms, 66 shockable rhythms) treated with therapeutic hypothermia between 2006 and 2012. None. Data were collected from electronic health records. Neurologic outcomes were dichotomized by Cerebral Performance Category at discharge and 6- to 12-month follow-up and analyzed via multivariable logistic regressions. Groups were similar, except nonshockable rhythm patients were more likely to have a history of diabetes mellitus (p = 0.01), be dialysis dependent (p = 0.01), and not have bystander cardiopulmonary resuscitation (p = 0.05). At discharge, 3 of 57 patients (5%) with nonshockable rhythm versus 28 of 66 (42%) with shockable rhythm had a favorable outcome (unadjusted odds ratio, 0.08; 95% CI, 0.02-0.3; adjusted odds ratio, 0.1; 95% CI, 0.03-0.4). At follow-up, 4 of 55 patients (7%) versus 29 of 60 (48%) with nonshockable rhythm and shockable rhythm, respectively, had a favorable Cerebral Performance Category (odds ratio, 0.08; 95% CI, 0.03-0.3; adjusted odds ratio, 0.09; 95% CI, 0.09-0.3). Among those surviving hospitalization, favorable neurologic outcome was more likely at long-term follow-up than at hospital discharge for both groups (odds ratio, 2.5; 95% CI, 1.3-4.7; adjusted odds ratio, 2.9; 95% CI, 1.4-6.2). No significant interaction between changes in neurologic status over time and presenting rhythm was seen (p = 0.93). These data indicate an association between initial nonshockable rhythm and significantly worse short- and long-term outcomes in patients treated with mild therapeutic hypothermia. Among survivors, neurologic status significantly improved over time for all patients and shockable rhythm patients and tended to improve over time for the small number of nonshockable rhythm patients who survived beyond hospitalization. No significant interaction between changes in neurologic status over time and presenting rhythm was seen.

Design of the PRINCESS trial: pre-hospital resuscitation intra-nasal cooling effectiveness survival study (PRINCESS)

BackgroundTherapeutic hypothermia (TH, 32-34°C) has been shown to improve neurological outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA) with ventricular tachycardia or fibrillation. Earlier initiation of TH may increase the beneficial effects. Experimental studies have suggested that starting TH during cardiopulmonary resuscitation (CPR) may further enhance its neuroprotective effects. The aim of this study was to evaluate whether intra-arrest TH (IATH), initiated in the field with trans nasal evaporative cooling (TNEC), would provide outcome benefits when compared to standard of care in patients being resuscitated from OHCA.Methods/designWe describe the methodology of a multi-centre, randomized, controlled trial comparing IATH delivered through TNEC device (Rhinochill, Benechill Inc., San Diego, CA, USA) during CPR to standard treatment, including TH initiated after hospital admission. The primary outcome is neurological intact survival defined as cerebral performance category 1–2 at 90 days among those patients who are admitted to the hospital. Secondary outcomes include survival at 90 days, proportion of patients achieving a return to spontaneous circulation (ROSC), the proportion of patients admitted alive to the hospital and the proportion of patients achieving target temperature (<34°C) within the first 4 hours since CA.DiscussionThis ongoing trial will assess the impact of IATH with TNEC, which may be able to rapidly induce brain cooling and have fewer side effects than other methods, such as cold fluid infusion. If this intervention is found to improve neurological outcome, its early use in the pre-hospital setting will be considered as an early neuro-protective strategy in OHCA.Trial registrationNCT01400373.

Abstracts from the 3rd Annual Therapeutic Hypothermia and Temperature Management ConferenceMarch 4–5, 2013Miami, FL

Abstracts from the 3rd Annual Therapeutic Hypothermia and Temperature Management ConferenceMarch 4–5, 2013Miami, FL

History of diabetes mellitus as a neurologic predictor in comatose survivors of cardiac arrest of cardiac origin treated with mild hypothermia

Aim To investigate the impact of a history of diabetes mellitus on the neurologic outcome in comatose survivors of cardiac arrest of cardiac origin treated with mild hypothermia. Methods A prospective observational study was performed between September 2003 and July 2008. Eighty comatose survivors of cardiac arrest of cardiac origin were treated with mild hypothermia. Neurologic outcome at the time of hospital discharge, 30-day survival, and complications were assessed. Results Twenty-four of the 80 patients (30%) had a history of diabetes. The rate of favorable neurologic outcome was significantly lower in diabetic (17%) than in nondiabetic patients (46%) ( p = 0.01). The rate of 30-day survival was lower in diabetic (33%) than in nondiabetic patients (54%), but the difference was not significant ( p = 0.10). Multivariate analysis suggested that a history of diabetes was an independent predictor of unfavorable neurologic outcome (odds ratio 7.00, 95% confidence interval 1.42–46.19, p = 0.03), but not for 30-day survival. There was no significant difference in the prevalence of complications. Conclusion A history of diabetes is associated with poor neurologic outcome in comatose survivors of cardiac arrest treated with mild hypothermia.

Bispectral index (BIS) helps predicting bad neurological outcome in comatose survivors after cardiac arrest and induced therapeutic hypothermia

Aim of the study Determine the use of bispectral index (BIS) as prognostic tool in therapeutic hypothermia (TH) treated comatose survivors after cardiac arrest (CA), regardless of initial rhythm, location or cause. Methods Prospective, single-centre, unblinded, observational cohort study in an 18 bed general ICU in a tertiary teaching hospital. 45 consecutive comatose patients admitted after CA and treated with TH were included. All patients were sedated with a standardised protocol including neuromuscular blockade. Induced TH was started as soon as possible after arrival in the hospital and continued for 24 h before slow rewarming. Sedation was stopped after reaching normothermia (36 °C). All patients benefited from maximal supportive intensive care and no therapeutic withdrawal or withholding was done unless bad neurological status was confirmed. Continuous BIS monitoring was performed over 72 h in all patients. Results 14 patients presented BIS values of zero (0) during their ICU stay. At 6 months 11 patients were dead, 1 remained comatose and 2 had severe neurological sequelae (CPC3). No patient of this group had good neurological outcome or improved his neurological outcome between ICU and 6-month follow-up. 31 patients had BIS values higher than 0. At 6 months of those, 11 died, none remained comatose, 3 had bad neurological outcome (CPC3) and 17 had no or minor neurological sequelae (CPC1-2). Thus no correlation between good outcome and BIS values higher than 0 is possible. Conclusions BIS values of 0 help predict bad neurological outcome after CA and induced hypothermia.

Therapeutic Hypothermia for Cardiopulmonary Resuscitation: Why, When and How

Therapeutic hypothermia has been shown to improve neurological outcome in comatose survivors of cardiac arrest. Uncontrolled hypothermia is, however, potentially deleterious because of its effects on various organ systems and physiologic functions. Clinicians are concerned that improper application of this treatment or overzealous cooling of their patients may result in serious complications and may increase the overall morbidity and mortality in that population. Induced hypothermia has, consequently, not achieved widespread use, despite an advisory statement from the International Liaison Committee on Resuscitation to cool comatose survivors of cardiac arrest. In this report, we critically review the literature on therapeutic hypothermia in individuals who have experienced cardiac arrest and the risks and complications associated with that treatment. Technical aspects and optimal timing for this intervention are also discussed, and appropriate monitoring of physiologic parameters is suggested.

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.