Therapeutische milde Hypothermie (32–34°C) ist die wirkungsvollste Behandlungsstrategie zur Verminderung neurologischer Schäden
nach Kreislaufstillstand. Die Richtlinien des Europäischen Rates für Wiederbelebung (European Resuscitation Council) empfehlen
die therapeutische milde Hypothermie (32–34°C) für 12–24h bei komatösen Patienten nach Kreislaufstillstand außerhalb des
Krankenhauses bei Kammerflimmern, und eventuell auch bei Patienten nach Kreislaufstillstand innerhalb des Krankenhauses bei
Asystolie oder pulsloser elektrischer Aktivität. Beobachtungsstudien zeigen, dass therapeutische Hypothermie zu keiner hämodynamischen
Beeinträchtigung von Patienten im kardiogenen Schock führt. Es gibt Hinweise darauf, dass auch bei diesen Patienten die neurologischen
Schäden durch therapeutische Hypothermie vermindert werden können. Ein möglichst frühes Erreichen der Zieltemperatur scheint
für die Wirksamkeit der therapeutischen milden Hypothermie wichtig zu sein. Weitere randomisierte Studien sind notwendig,
um eindeutige Antworten auf Fragen nach der exakten Temperatur, der Dauer der Hypothermie und der Erwärmungsrate zu erhalten
und im Folgenden den Effekt der Behandlung weiter zu optimieren.
Therapeutic mild hypothermia (32–34°C) is one of the most efficacious therapies to prevent neurologic damage after cardiac
arrest. The guidelines of the European Resuscitation Council recommend that “unconscious adult patients with spontaneous circulation
after out-of-hospital cardiac arrest should be cooled to 32–34°C for 12–24hours when the initial rhythm was ventricular fibrillation
(VF). Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest.” Observational studies show that
patients in cardiogenic shock are not compromised by therapeutic hypothermia, and that even in these patients neurologic outcome
is better when they receive therapeutic hypothermia. Reaching the target temperature more quickly may improve the effect of
the therapy. Further randomised studies are necessary to elucidate important questions, such as the exact target temperature,
length of therapy and rewarming rates in order to further improve the effect of therapeutic hypothermia.
[Show abstract][Hide abstract] ABSTRACT: There is sufficient evidence that therapeutic hypothermia after non-traumatic cardiac arrest improves neurological outcome and reduces mortality. Many different invasive and non-invasive cooling devices are currently available. Our purpose was to show the efficacy, safety and feasibility using a non-invasive cooling device to control patient temperature within a range of 33-37 degrees C.
A convenience sample of patients who have been resuscitated successfully from cardiac arrest and were intended for mild hypothermia therapy according to the guidelines and inclusion criteria were studied in a prospective observational case series at an emergency department of a tertiary care university hospital. The Medivance Arctic Sun System provides a new, non-invasive approach to reach a target temperature of 33 degrees C quickly, to maintain the target temperature for 24h, and then to actively re-warm at 0.4 degrees C/h to normothermia. Cooling was applied using the Arctic Sun in 27 patients. Data are presented as median and the interquartile range (25, 75%).
Median age was 58 (49.5, 70) years. Time from cooling start to target temperature was 137 (96, 168)min, cooling rate was 1.2 degrees C/h (0.8, 1.5), stability of target temperature during hypothermia maintenance phase was satisfactory at 33.0 degrees C (32.9, 33.1), and duration of re-warming was 428 (394, 452)min.
Using the Arctic Sun System in post-resuscitation care medicine for cooling cardiac arrest survivors is feasible and has proven to be highly effective in lowering patients' temperature rapidly without inducing skin irritations.
[Show abstract][Hide abstract] ABSTRACT: The earliest initiation of mild hypothermia after resuscitation from cardiac arrest is crucial. This study aimed to evaluate the feasibility and safety of out-of-hospital surface cooling in such cases.
Cooling pads stored below 0 degrees C in the ambulance were applied as soon as possible after restoration of spontaneous circulation in the out-of-hospital setting. This continued in the emergency department until an oesophageal temperature of 34 degrees C was reached, when the pads were removed. A target temperature of 33 degrees C was maintained for 24 h. Results are given as median and interquartile range.
From September 2006 to January 2007, 15 victims of cardiac arrest were included. Cooling was initiated at 12 (8.5-15) min after restoration of spontaneous circulation. Oesophageal temperatures decreased from 36.6 (36.2-36.6) degrees C to 33 degrees C within 70 (55-106) min. Hospital admission was at 45 (34-52) min, with oesophageal temperatures of 35.4 (34.6-35.9) degrees C; the target 33 degrees C was achieved 50 (29-82) min after admission. No skin lesions were observed.
Non-invasive surface cooling immediately after resuscitation from cardiac arrest, in the out-of-hospital setting, proved to be feasible, fast and safe. Whether early cooling will improve neurological outcome needs to be determined in future studies.
[Show abstract][Hide abstract] ABSTRACT: Therapeutic hypothermia has been shown to increase survival after out-of-hospital cardiac arrest (OHCA). The trials documenting such benefit excluded patients with cardiogenic shock and only a few patients were treated with percutaneous coronary intervention prior to admission to an intensive care unit (ICU). We use therapeutic hypothermia whenever cardiac arrest patients do not wake up immediately after return of spontaneous circulation.
This paper reports the outcome of 50 OHCA patients with ventricular fibrillation admitted to a tertiary referral hospital for immediate coronary angiography and percutaneous coronary intervention when indicated. Patients were treated with intra-aortic balloon counterpulsation (IABP) (23 of 50 patients) if indicated. All patients who were still comatose were treated with therapeutic hypothermia at 32-34 degrees C for 24 h before rewarming. The end-points were survival and cerebral performance category (CPC: 1, best; 5, dead) after 6 months.
Forty-one patients (82%) survived until 6 months. Thirty-four patients (68%) were in CPC 1 or 2, and seven (14%) were in CPC 3. Of the 23 patients treated with IABP, 14 (61%) survived with CPC 1 or 2. In patients not treated with IABP, 20 patients (74%) survived with CPC 1 or 2. Forty patients (80%) developed myocardial infarction. Percutaneous coronary intervention was performed in 36 patients (72%).
In OHCA survivors who reached our hospital, the survival rate was high and the neurological outcome acceptable. Our results indicate that the use of therapeutic hypothermia is justified even in haemodynamically unstable patients and those treated with percutaneous coronary intervention.
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