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Muehlschlegel G, Kubicki R, Jacobs-LeVan J, Kroll J, Klemm R, Humburger F, Stiller B, Fleck T. Neurological Impact of Slower Rewarming during Bypass Surgery in Infants. Thorac Cardiovasc Surg 2024; 72:e7-e15. [PMID: 38909608 DOI: 10.1055/s-0044-1787650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Hypothermia is a neuroprotective strategy during cardiopulmonary bypass. Rewarming entailing a rapid rise in cerebral metabolism might lead to secondary neurological sequelae. In this pilot study, we aimed to validate the hypothesis that a slower rewarming rate would lower the risk of cerebral hypoxia and seizures in infants. METHODS This is a prospective, clinical, single-center study. Infants undergoing cardiac surgery in hypothermia were rewarmed either according to the standard (+1°C in < 5 minutes) or a slow (+1°C in > 5-8 minutes) rewarming strategy. We monitored electrocortical activity via amplitude-integrated electroencephalography (aEEG) and cerebral oxygenation by near-infrared spectroscopy during and after surgery. RESULTS Fifteen children in the standard rewarming group (age: 13 days [5-251]) were cooled down to 26.6°C (17.2-29.8) and compared with 17 children in the slow-rewarming group (age: 9 days [4-365]) with a minimal temperature of 25.7°C (20.1-31.4). All neonates in both groups (n = 19) exhibited suppressed patterns compared with 28% of the infants > 28 days (p < 0.05). During rewarming, only 26% of the children in the slow-rewarming group revealed suppressed aEEG traces (vs. 41%; p = 0.28). Cerebral oxygenation increased by a median of 3.5% in the slow-rewarming group versus 1.5% in the standard group (p = 0.9). Our slow-rewarming group revealed no aEEG evidence of any postoperative seizures (0 vs. 20%). CONCLUSION These results might indicate that a slower rewarming rate after hypothermia causes less suppression of electrocortical activity and higher cerebral oxygenation during rewarming, which may imply a reduced risk of postoperative seizures.
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Affiliation(s)
- Geeske Muehlschlegel
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Baden-Württemberg, Germany
| | - Rouven Kubicki
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
| | - Julia Jacobs-LeVan
- Departments of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Johannes Kroll
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Baden-Württemberg, Germany
| | - Rolf Klemm
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Baden-Württemberg, Germany
| | - Frank Humburger
- Department of Anesthesiology, University of Freiburg Medical Center Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
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Sugita S, Obata M, Hasunuma F, Sakamoto A. Intraoperative cardiac arrest caused by unexpected vasospastic angina requiring prolonged resuscitation using extracorporeal membrane oxygenation: a case report. JA Clin Rep 2023; 9:77. [PMID: 37940795 PMCID: PMC10632342 DOI: 10.1186/s40981-023-00667-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Vasospastic angina (VSA) occurring during surgery is rare but can lead to sudden intraoperative cardiac arrest. CASE PRESENTATION A 77-year-old man with hypertension, and no history of coronary artery disease, displayed an abrupt ST-segment elevation on the electrocardiogram (ECG) during laparoscopic inguinal hernia surgery under general anesthesia. Subsequently, ventricular fibrillation (VF) occurred, with a finding suggesting ischemic myocardial contracture by transesophageal echocardiography. VF was refractory to cardiopulmonary resuscitation (CPR), and veno-arterial extracorporeal membrane oxygenation (VA ECMO) was introduced. Spontaneous circulation resumed 77 min post-cardiac arrest. VSA was confirmed through the patient's clinical course and coronary angiography. Subsequently, VA ECMO was terminated, and the patient was discharged uneventfully. CONCLUSIONS Extracorporeal CPR may be a valuable alternative to extended resuscitation for refractory ventricular arrhythmias by VSA.
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Affiliation(s)
- Shinji Sugita
- Department of Anesthesiology, Nippon Medical School Musashi-kosugi Hospital, 1-383 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan.
| | - Masanobu Obata
- Department of Anesthesiology, Nippon Medical School Musashi-kosugi Hospital, 1-383 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Fumihiko Hasunuma
- Department of Anesthesiology, Nippon Medical School Musashi-kosugi Hospital, 1-383 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Atsuhiro Sakamoto
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
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3
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Soar J, Becker LB, Berg KM, Einav S, Ma Q, Olasveengen TM, Paal P, Parr MJA. Cardiopulmonary resuscitation in special circumstances. Lancet 2021; 398:1257-1268. [PMID: 34454688 DOI: 10.1016/s0140-6736(21)01257-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022]
Abstract
Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.
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Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Lance B Becker
- Emergency Medicine, Zucker School of Medicine at Hofstra-Northwell, Northwell Health, New Hyde Park, NY, USA
| | | | - Sharon Einav
- Surgical Intensive Care, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Qingbian Ma
- Emergency Medicine, Peking University Third Hospital, Beijing, China
| | | | - Peter Paal
- Anaesthesiology and Intensive Care, St John of God Hospital, Paracelsus, Salzburg, Austria
| | - Michael J A Parr
- Intensive Care, Liverpool University Hospital, University of New South Wales, Sydney, NSW, Australia; Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
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4
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Moreda M, Beacham PS, Reese A, Mulkey MA. Increasing the Effectiveness of Targeted Temperature Management. Crit Care Nurse 2021; 41:59-63. [PMID: 34595495 DOI: 10.4037/ccn2021637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
TOPIC Targeted temperature management and therapeutic hypothermia are essential components of the multimodal approach to caring for compromised patients after cardiac arrest and severe traumatic brain injury. CLINICAL RELEVANCE The continuously evolving science necessitates summation of individual facets and concepts to enhance knowledge and application for optimally delivering care. Targeted temperature management is a complex therapy that requires fine-tuning the most effective interventions to maintain high-quality targeted temperature management and maximize patient outcomes. PURPOSE To describe the underlying pathophysiology of fever and the importance of manipulating water temperature and of preventing and treating shivering during that process. CONTENT COVERED This article discusses nursing considerations regarding the care of patients requiring targeted temperature management that are necessary to improve patient outcomes.
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Affiliation(s)
- Melissa Moreda
- Melissa Moreda is a clinical nurse specialist at Duke Raleigh Hospital, Durham, North Carolina
| | - Pamela S Beacham
- Pamela S. Beacham is a clinical nurse specialist at University of North Carolina-Rex Hospital, Raleigh, North Carolina
| | - Angela Reese
- Angela Reese is a clinical nurse educator at University of North Carolina-Rex Hospital
| | - Malissa A Mulkey
- Malissa A. Mulkey is a postdoctoral research felllow at Indiana University-Purdue University, Indianapolis, Indiana, and a clinical nurse specialist at University of North Carolina-Rex Hospital
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Kander T, Ullén S, Dankiewicz J, Wise MP, Schött U, Rundgren M. Bleeding Complications After Cardiac Arrest and Targeted Temperature Management, a Post Hoc Study of the Targeted Temperature Management Trial. Ther Hypothermia Temp Manag 2018; 9:177-183. [PMID: 30523732 DOI: 10.1089/ther.2018.0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Target Temperature Management (TTM) is standard care following out of hospital cardiac arrest (OHCA). The aim of the study was to evaluate if treatment temperature (33°C or 36°C) or other predefined variables were associated with the occurrence of bleeding in the TTM study. This study is a predefined, post hoc analysis of the TTM trial, a multinational randomized controlled trial comparing treatment at 33°C and 36°C for 24 hours after OHCA with return of spontaneous circulation. Bleeding events from several locations were registered daily. The main outcome measure was occurrence of any bleeding during the first 3 days of intensive care. Risk factors for bleeding, including temperature allocation, were evaluated. Complete data were available for 722/939 patients. Temperature allocation was not associated with bleeding either in the univariable (p = 0.95) or in the primary multivariable analysis (odds ratio [OR] 0.95; 95% confidence interval [CI] 0.64-1.41, p = 0.80). A multiple imputation model, including all patients, was used as a sensitivity analysis, rendering similar results (OR 0.98; 95% CI 0.69-1.38, p = 0.92). Factors associated with bleeding were increasing age, female sex, and angiography with percutaneous coronary intervention (PCI) within 36 hours of cardiac arrest (CA) in both the primary and the sensitivity analysis. TTM at 33°C, when compared to TTM at 36°C, was not associated with an increased incidence of bleeding during the first 3 days of intensive care after CA. Increasing age, female gender, and PCI were independently associated with any bleeding the first 3 days after CA.
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Affiliation(s)
- Thomas Kander
- Department of Clinical Sciences, Anesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden-Forum South Skane University Hospital, Lund, Sweden
| | - Josef Dankiewicz
- Department of Cardiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Ulf Schött
- Department of Clinical Sciences, Anesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Malin Rundgren
- Department of Clinical Sciences, Anesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
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6
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Cardiovascular focus editorial ICM 2018. Intensive Care Med 2018; 44:1995-1996. [PMID: 30284636 DOI: 10.1007/s00134-018-5396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
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7
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Mongardon N, Kohlhauer M, Lidouren F, Barretto M, Micheau P, Adam C, Dhonneur G, Ghaleh B, Tissier R. Targeted Temperature Management With Total Liquid Ventilation After Ischemic Spinal Cord Injury. Ann Thorac Surg 2018; 106:1797-1803. [PMID: 30120942 DOI: 10.1016/j.athoracsur.2018.06.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/08/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ischemic spinal cord injury is a devastating condition after aortic surgery. We determined whether ultrafast and short whole-body hypothermia provided by total liquid ventilation (TLV) attenuated lower limb paralysis after aortic cross-clamping with a targeted temperature management at 33°C versus 36°C. METHODS Anesthetized rabbits were submitted to infrarenal aortic cross-clamping during 15 min. A control group (n = 7) was maintained at normothermia (38°C to 38.5°C) with conventional mechanical ventilation. In TLV groups, TLV was started after reperfusion and maintained during 30 min with a target temperature at either 33°C or 36°C (TLV-33°C and TLV-36°C, respectively; n = 7 in each condition). After TLV, animals were resumed to conventional ventilation. Hypothermia was maintained during 120 min, before rewarming and awakening. Hind limb motor function was assessed with modified Tarlov score at day 2 and infarct size in the spinal cord was determined using triphenyltetrazolium chloride staining. RESULTS Target temperature was achieved within 20 minutes in the two TLV groups. At day 2, the modified Tarlov score was significantly lower in the control group, as compared with TLV-33°C and TLV-36°C groups (0.0 ± 0.0 versus 3.1 ± 0.7 and 2.6 ± 0.6, respectively). The infarct size of the spinal cord was also significantly higher in the control group compared with TLV-33°C and TLV-36°C groups (75% ± 10% versus 32% ± 7% and 28% ± 10%, respectively). Neither motor function nor infarct size differed significantly between TLV-33°C and TLV-36°C groups. CONCLUSIONS Ultrafast hypothermic TLV attenuates spinal cord injury when applied after ischemic insult. Neurological outcome was similar with targeted temperature management at either 33°C or 36°C.
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Affiliation(s)
- Nicolas Mongardon
- Inserm, U955, Equipe 3, Créteil, France; Université Paris Est, UMR_S955, UPEC, DHU A-TVB, Créteil, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France; Service d'Anesthésie-Réanimation, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Matthias Kohlhauer
- Inserm, U955, Equipe 3, Créteil, France; Université Paris Est, UMR_S955, UPEC, DHU A-TVB, Créteil, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Fanny Lidouren
- Inserm, U955, Equipe 3, Créteil, France; Université Paris Est, UMR_S955, UPEC, DHU A-TVB, Créteil, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Mariana Barretto
- Inserm, U955, Equipe 3, Créteil, France; Université Paris Est, UMR_S955, UPEC, DHU A-TVB, Créteil, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | | | - Clovis Adam
- Service d'Anatomo-pathologie, Hôpital Bicêtre, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Gilles Dhonneur
- Service d'Anesthésie-Réanimation, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Bijan Ghaleh
- Inserm, U955, Equipe 3, Créteil, France; Université Paris Est, UMR_S955, UPEC, DHU A-TVB, Créteil, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Renaud Tissier
- Inserm, U955, Equipe 3, Créteil, France; Université Paris Est, UMR_S955, UPEC, DHU A-TVB, Créteil, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.
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8
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Krawczyk P, Andres J. Unexpected perioperative cardiac arrest. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Ivascu NS, Shen L, Noguera E, Flynn BC. Noteworthy Literature published in 2017 for Cardiac Critical Care. Semin Cardiothorac Vasc Anesth 2018; 22:18-26. [PMID: 29338605 DOI: 10.1177/1089253217753395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In 2017, many high-impact articles appeared in the literature. This is the third edition of an annual review of articles related to postoperative cardiac critical care that may affect the cardiac anesthesiologist. This year explores vasopressor and inotropic support, timing of renal replacement therapy, management of postoperative respiratory insufficiency, and targeted temperature therapy.
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Affiliation(s)
| | - Liang Shen
- 1 Weill Cornell Medical College, New York, NY, USA
| | - Edward Noguera
- 2 Cleveland Clinic Florida, Outcomes Research Consortium, Weston, FL, USA
| | - Brigid C Flynn
- 3 University of Kansas Medical Center, Kansas City, KS, USA
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10
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Hur M, Lee HC, Lee KH, Kim JT, Jung CW, Park HP. The incidence and characteristics of 3-month mortality after intraoperative cardiac arrest in adults. Acta Anaesthesiol Scand 2017; 61:1095-1104. [PMID: 28799206 DOI: 10.1111/aas.12955] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is little information about clinical outcomes after intraoperative cardiac arrest (IOCA). We determined the incidence and characteristics of 3-month mortality after IOCA. METHODS The electronic medical records of 238,648 adult surgical patients from January 2005 to December 2014 were reviewed retrospectively. Characteristics of IOCA were documented using the Utstein reporting template. RESULTS IOCA occurred in 50 patients (21/100,000 surgeries). Nineteen patients died in the operating room, and further 12 patients died within 3 months post-arrest (total mortality: 62%). Three survivors at 3 months post-arrest had unfavourable neurological outcome. Finally, 34 patients showed unfavourable clinical outcomes at 3 months post-arrest. The incidences of non-cardiac surgery, emergency, pre-operative intubation state, non-shockable initial cardiac rhythm, hypovolaemic shock, pre-operative complications-induced cardiac arrest, non-anaesthetic cause of cardiac arrest, intra- and post-arrest transfusion, and continuous infusion of inotrope or vasopressor in intensive care unit (ICU) were significantly higher in non-survivors at 3 months post-arrest. Total epinephrine dose administrated during arrest was higher, and the duration of cardiac compressions was longer in non-survivors at 3 months post-arrest. CONCLUSIONS In this study, the incidence of IOCA was 21/100,000 surgeries and the 3-month mortality rate after IOCA was 62%. Several factors including surgical emergency, non-shockable initial cardiac rhythm, pre-operative complications, surgical complications, long duration of cardiac compressions, high total epinephrine dose, transfusion, and continuous infusion of inotropes or vasopressors in ICU seemed to be risk factors for 3-month mortality after IOCA. These risk factors should be considered in the light of relatively small sample size of this study.
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Affiliation(s)
- M. Hur
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - H.-C. Lee
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - K. H. Lee
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - J.-T. Kim
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - C.-W. Jung
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - H.-P. Park
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
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11
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Prolonged TTM – enhanced hypocoagulation and bleeding? Resuscitation 2017; 118:A3-A4. [DOI: 10.1016/j.resuscitation.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/01/2017] [Indexed: 11/19/2022]
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12
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Small observational studies and data sharing: fuel for debate and coins for the piggy bank of evidence. Intensive Care Med 2017; 43:575-577. [DOI: 10.1007/s00134-017-4696-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
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