Arrich J; European Resuscitation Council Hypothermia After Cardiac Arrest Study Group: Clinical application of mild therapeutic hypothermia after cardiac arrest

Critical Care Medicine (Impact Factor: 6.31). 05/2007; 35(4):1041-7. DOI: 10.1097/01.CCM.0000259383.48324.35
Source: PubMed


Postresuscitative mild hypothermia lowers mortality, reduces neurologic impairment after cardiac arrest, and is recommended by the International Liaison Committee on Resuscitation. The European Resuscitation Council Hypothermia After Cardiac Arrest Registry was founded to monitor implementation of therapeutic hypothermia, to observe feasibility of adherence to the guidelines, and to document the effects of hypothermic treatment in terms of complications and outcome.
Cardiac arrest protocols, according to Utstein style, with additional protocols on cooling and rewarming procedures and possible adverse events are documented.
Between March 2003 and June 2005, data on 650 patients from 19 sites within Europe were entered.
Patients who had cardiac arrest with successful restoration of spontaneous circulation were studied.
Of all patients, 462 (79%) received therapeutic hypothermia, 347 (59%) were cooled with an endovascular device, and 114 (19%) received other cooling methods such as ice packs, cooling blankets, and cold fluids. The median cooling rate was 1.1 degrees C per hour. Of all hypothermia patients, 15 (3%) had an episode of hemorrhage and 28 patients (6%) had at least one episode of arrhythmia within 7 days after cooling. There were no fatalities as a result of cooling.
Therapeutic hypothermia is feasible and can be used safely and effectively outside a randomized clinical trial. The rate of adverse events was lower and the cooling rate was faster than in clinical trials published.

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    • "Acute general and local induction of hypothermia as a first line of neuroprotection postcontusive SCI is the focus of research in our laboratory. Acute hypothermia has been investigated in this study and other studies as a neuroprotective treatment with encouraging results for a variety of conditions such as stroke (Piironen Auriat, 2014), cerebral aneurysm (van der Worp et al., 2007; Chang and Marshall, 2012; Lakhan and Pamplona, 2012), traumatic brain injury (TBI) (Marion et al., 1997; Faridar et al., 2011; Lotocki et al., 2011), cardiac arrest (The Hypothermia after Cardiac Arrest Study Group, 2002; Arrich, 2007; Belliard et al., 2007; Bro- Jeppesen et al., 2009; Batista et al., 2010; Beddingfield and Clark, 2012), and ischemia–reperfusion injury (Kawamura et al., 2006). Studies with mild (>33°C) and moderate (<32°C) hypothermia have also shown benefits in the treatment of SCI (Kwon et al., 2008; Dietrich et al., 2009, 2011b). "
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    ABSTRACT: Hypothermia is known to be neuroprotective and is one of the most effective and promising first-line treatments for central nervous system (CNS) trauma. At present, induction of local hypothermia, as opposed to general hypothermia, is more desired because of its ease of application and safety; fewer side effects and an absence of severe complications have been noted. Local hypothermia involves temperature reduction of a small and specific segment of the spinal cord. Our group has previously shown the neuroprotective effect of short-term, acute moderate general hypothermia through improvements in electrophysiological and motor behavioral assessments, as well as histological examination following contusive spinal cord injury (SCI) in rats. We have also shown the benefit of using short-term local hypothermia versus short-term general hypothermia post-acute SCI. The overall neuroprotective benefit of hypothermia can be categorized into three main components: (1) induction modality, general versus local, (2) invasive, semi-invasive or noninvasive, and (3) duration of hypothermia induction. In this study, a series of experiments were designed to investigate the feasibility, long-term safety, as well as eventual complications and side effects of prolonged, semi-invasive, moderate local hypothermia (30°C±0.5°C for 5 and 8 hours) in rats with uninjured spinal cord while maintaining their core temperature at 37°C±0.5°C. The weekly somatosensory evoked potential and motor behavioral (Basso, Beattie and Bresnahan) assessments of rats that underwent 5 and 8 hours of semi-invasive local hypothermia, which revealed no statistically significant changes in electrical conductivity and behavioral outcomes. In addition, 4 weeks after local hypothermia induction, histological examination showed no anatomical damages or morphological changes in their spinal cord structure and parenchyma. We concluded that this method of prolonged local hypothermia is feasible, safe, and has the potential for clinical translation.
    Full-text · Article · Jun 2015
    • "Quality Good HACA 2002 Bernard 1997 Wolfrum 2008 Kozinski 2008 Belliard 2007 Zeiner 2000 Felberg 2001 Hovdenes 2007 Nielsen 2009 Tomte 2011 Lopez-de-Sa 2012 Fair Bernard 2002 Holzer 2006 Arrich 2007 Schefold 2009 Kulstad 2010 Kory 2012 Zimmermann 2013 Al-Senani 2004 Kliegel 2005 Skulec 2007 Flint 2007 Laish-Farkash 2007 Takeuchi 2009 Heard 2010 Prior 2010 Gillies 2010 Jarrah 2011 Kory 2011 Kim 2011 Lebiedz 2012 Pittl 2013 Testori 2013 de Waard "
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    ABSTRACT: Aim Prognosis after cardiac arrest in the era of modern critical care is still poor with a high mortality of approximately 90%. Around 30% of the survivors have neurological impairments. Targeted Temperature Management (TTM) is the only treatment option which can improve mortality and neurological outcome. It is so far unclear if bleeding complications occur more often in patients undergoing TTM treatment. Methods We conducted a systematic literature research in September 2013 including three major databases i.e. MEDLINE, EMBASE and CENTRAL. All studies were rated in respect to the ILCOR Guidelines and concerning their level of evidence and quality. We then performed a meta-analysis on bleeding disposition under TTM. Results We initially found 941 studies out of which 34 matched our requirements and were thus included in our overview. Five studies including 599 patients were summarized in a meta-analysis concerning bleeding complications of all severities. There was a trend towards higher bleeding in patients treated with TTM (RR: 1.30, 95 % CI: 0.97-1.74) which did not reach significance (p = 0.085). Seven studies with an overall 599 patients were included in our meta-analysis on bleeding requiring transfusion. There was no significant difference in the incidence of severe bleeding with a risk ratio of 0.97 (95 % CI: 0. 61-1.56, p = 0.909). Conclusions The data included in our meta-analysis indicate that, concerning the risk of bleeding, TTM is a safe method for patients after cardiac arrest. We did not observe a significantly higher risk for bleeding in patients undergoing TTM.
    No preview · Article · Nov 2014 · Resuscitation
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    • "Two prospective randomized trials and various retrospective analysis supported that therapeutic hypothermia after ventricular fibrillation cardiac arrest improves neurologic outcome [1,2,5]. Nevertheless, this therapeutic benefit has not been finally demonstrated in patients with return of circulation from non- shockable rhythms and in patients after in- hospital resuscitation [6]. In our study we observed patients after previous cardiac surgery resuscitated from cardiac arrest due to shockable and non- shockable arrhythmia who were treated with therapeutic hypothermia to a body core temperature between 32 and 33°C for a period of 24 hours. "
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    ABSTRACT: Despite many years of intensive research sudden cardiac death is one of the most common causes of death all over the world. The European Resuscitation Council (ERC) recommends the use of moderate therapeutic hypothermia for 12--24 hours to improve neurological outcome. However, the beneficial effect of this therapy on outcomes for cardiac surgery patients with In- Hospital- Resuscitation (IHR) has not been well studied.The purpose of this single center analysis was to investigate our first experience in a non -- selected IHR population, where hypothermia was induced independent from initial heart rhythm disturbance. A total of 20 resuscitated patients who were treated in our institution between January 2010 and December 2011 formed the study cohort. In all patients post- resuscitation course was significantly prolonged with severe low cardiac output syndrome in six patients (30%). Overall four patients (20%) sustained septicemia with the need for high dose inotropic support. The 30 day mortality was 30% (six of twenty). However, stroke with severe neurological impairment appeared in only four patients (20%) after resuscitation with subsequent therapeutic hypothermia. With our observation study we could demonstrate the benefits for neurological outcome due to therapeutic hypothermia in cardiac surgery patients after successful resuscitation. However post- resuscitation treatment should focus on sufficient therapeutic strategies to avoid the distinctive short term morbidity and mortality.
    Full-text · Article · Sep 2013 · Journal of Cardiothoracic Surgery
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