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Aziz S, Clough M, Butterfield E, Starr Z, Lachowycz K, Price J, Barnard EB, Rees P. The association between prehospital post-return of spontaneous circulation core temperature and survival after out-of-hospital cardiac arrest. Eur J Emerg Med 2024; 31:356-362. [PMID: 38752563 PMCID: PMC11356685 DOI: 10.1097/mej.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/04/2024] [Indexed: 08/30/2024]
Abstract
BACKGROUND AND IMPORTANCE Following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA), a low body temperature on arrival at the hospital and on admission to the ICU is reportedly associated with increased mortality. Whether this association exists in the prehospital setting, however, is unknown. OBJECTIVE The objective of this study was to investigate whether the initial, prehospital core temperature measured post-ROSC is independently associated with survival to hospital discharge in adult patients following OHCA. DESIGN, SETTING AND PARTICIPANTS This retrospective observational study was conducted at East Anglian Air Ambulance, a physician-paramedic staffed Helicopter Emergency Medical Service in the East of England, UK. Adult OHCA patients attended by East Anglian Air Ambulance from 1 February 2015 to 30 June 2023, who had post-ROSC oesophageal temperature measurements were included. OUTCOME MEASURE AND ANALYSIS The primary outcome measure was survival to hospital discharge. Core temperature was defined as the first oesophageal temperature recorded following ROSC. Multivariable logistic regression evaluated the adjusted association between core temperature and survival to hospital discharge. MAIN RESULTS Resuscitation was attempted in 3990 OHCA patients during the study period, of which 552 patients were included in the final analysis. The mean age was 61 years, and 402 (72.8%) patients were male. Among them, 194 (35.1%) survived to hospital discharge. The mean core temperature was lower in nonsurvivors compared with those who survived hospital discharge; 34.6 and 35.2 °C, respectively (mean difference, -0.66; 95% CI, -0.87 to -0.44; P < 0.001). The adjusted odds ratio for survival was 1.41 (95% CI, 1.09-1.83; P = 0.01) for every 1.0 °C increase in core temperature between 32.5 and 36.9 °C. CONCLUSION In adult patients with ROSC following OHCA, early prehospital core temperature is independently associated with survival to hospital discharge.
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Affiliation(s)
- Shadman Aziz
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - Molly Clough
- Newcastle University School of Medicine, Newcastle University, Newcastle upon Tyne
| | - Emma Butterfield
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - Zachary Starr
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - Kate Lachowycz
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - James Price
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Ed B.G. Barnard
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham
| | - Paul Rees
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
- Barts Interventional Group, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
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Miao B, Skaar JR, O'Hara M, Post A, Kelly T, Abella BS. A Systematic Literature Review to Assess Fever Management and the Quality of Targeted Temperature Management in Critically Ill Patients. Ther Hypothermia Temp Manag 2024; 14:68-79. [PMID: 37219898 DOI: 10.1089/ther.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Targeted temperature management (TTM) has been proposed to reduce mortality and improve neurological outcomes in postcardiac arrest and other critically ill patients. TTM implementation may vary considerably among hospitals, and "high-quality TTM" definitions are inconsistent. This systematic literature review in relevant critical care conditions evaluated the approaches to and definitions of TTM quality with respect to fever prevention and the maintenance of precise temperature control. Current evidence on the quality of fever management associated with TTM in cardiac arrest, traumatic brain injury, stroke, sepsis, and critical care more generally was examined. Searches were conducted in Embase and PubMed (2016 to 2021) following PRISMA guidelines. In total, 37 studies were identified and included, with 35 focusing on postarrest care. Frequently-reported TTM quality outcomes included the number of patients with rebound hyperthermia, deviation from target temperature, post-TTM body temperatures, and number of patients achieving target temperature. Surface and intravascular cooling were used in 13 studies, while one study used surface and extracorporeal cooling and one study used surface cooling and antipyretics. Surface and intravascular methods had comparable rates of achieving target temperature and maintaining temperature. A single study showed that patients with surface cooling had a lower incidence of rebound hyperthermia. This systematic literature review largely identified cardiac arrest literature demonstrating fever prevention with multiple TTM approaches. There was substantial heterogeneity in the definitions and delivery of quality TTM. Further research is required to define quality TTM across multiple elements, including achieving target temperature, maintaining target temperature, and preventing rebound hyperthermia.
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Affiliation(s)
| | | | | | - Andrew Post
- Trinity Life Sciences, Waltham, Massachusetts, USA
| | - Tim Kelly
- Becton Dickinson, Franklin Lakes, New Jersey, USA
| | - Benjamin S Abella
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wang D, Wang L, Sun Y, Kong F, Jiang Y, An M, Xia Y, Gong P, Yang Y. Effects of temperature control on hyperthermia-related cardiac dysfunction in a porcine model of cardiac arrest. Cryobiology 2023; 110:49-55. [PMID: 36509162 DOI: 10.1016/j.cryobiol.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
The outcome of cardiac arrest is worse when there is fever after spontaneous circulation is restored (ROSC). The purpose of this study was to investigate the mechanism of post-ROSC cardiac dysfunction after hyperthermia treatment and the effects of temperature control. Twenty-four male Bama minipigs were randomized into 3 groups (8 per group): CPR + controlled normothermia (CN), CPR + hyperthermia (HT), and CPR + therapeutic mild hypothermia (TMH). Defibrillation was given to pigs with ventricular fibrillation after 8 min of untreated fibrillation. Subsequently, these animals received the post-ROSC treatments of hyperthermia (38 °C), controlled normothermia (37 °C) or hypothermia (33 °C) according to the groups. Hemodynamic parameters, left ventricular ejection fraction, blood samples and myocardial tissues were assessed. At 24 h after the post-ROSC treatments, the pigs treated with hyperthermia showed increments in heart rate and plasma cardiac troponin I, and decreases in mean arterial pressure, cardiac index, and left ventricular ejection fraction, compared to those with the controlled normothermia pigs. However, the deterioration of the above parameters can be attenuated by TMH. The pigs in the TMH group also had a reduced percentage of apoptotic cardiomyocytes, an increased anti-apoptotic Bcl-2/Bax ratio and a decreased caspase-3 activity in myocardium, as compared with both controlled normothermia and hyperthermia pigs. In conclusion, hyperthermia is associated with a worse myocardial dysfunction. TMH improves hyperthermia-induced myocardial dysfunction by attenuating apoptosis in a porcine model of cardiac arrest.
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Affiliation(s)
- Dongxia Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Ling Wang
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Yuanyuan Sun
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Fang Kong
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Yi Jiang
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Mengmeng An
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Yunlong Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Ping Gong
- Department of Emergency, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
| | - Yanzong Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
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Lin T, Yao Y, Xu Y, Huang HB. Neuromuscular Blockade for Cardiac Arrest Patients Treated With Targeted Temperature Management: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:780370. [PMID: 35685629 PMCID: PMC9171045 DOI: 10.3389/fphar.2022.780370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/02/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Neuromuscular-blocking agents (NMBA) are often administered to control shivering in comatose cardiac arrest (CA) survivors during targeted temperature management (TTM) management. Thus, we performed a systematic review and meta-analysis to investigate the effectiveness and safety of NMBA in such a patient population. Methods: We searched for relevant studies in PubMed, Embase, and the Cochrane Library until 15 Jul 2021. Studies were included if they reported data on any of the predefined outcomes in adult comatose CA survivors managed with any NMBA regimens. The primary outcomes were mortality and neurological outcome. Results were expressed as odds ratio (OR) or mean difference (MD) with an accompanying 95% confidence interval (CI). Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Data Synthesis: We included 12 studies (3 randomized controlled trials and nine observational studies) enrolling 11,317 patients. These studies used NMBA in three strategies: prophylactic NMBA, bolus NMBA if demanded, or managed without NMBA. Pooled analysis showed that CA survivors with prophylactic NMBA significantly improved both outcomes of mortality (OR 0.74; 95% CI 0.64-0.86; I 2 = 41%; p < 0.0001) and neurological outcome (OR 0.53; 95% CI 0.37-0.78; I 2 = 59%; p = 0.001) than those managed without NMBA. These results were confirmed by the sensitivity analyses and subgroup analyses. Only a few studies compared CA survivors receiving continuous versus bolus NMBA if demanded strategies and the pooled results showed no benefit in the primary outcomes between the two groups. Conclusion: Our results showed that using prophylactic NMBA strategy compared to the absence of NMBA was associated with improved mortality and neurologic outcome in CA patients undergoing TTM. However, more high-quality randomized controlled trials are needed to confirm our results.
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Affiliation(s)
- Tong Lin
- Department of Reproductive Endocrinology, Hospital of Traditional Chinese Medicine, Zhaoqing, China
| | - Yan Yao
- Department of Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yuan Xu
- Department of Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Hui-Bin Huang
- Department of Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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Yoshimura S, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Yagi Y, Kishimoto M, Kim SH, Hayashi Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Nakamura F, Matsuyama T, Okada Y, Nishioka N, Matsui S, Kimata S, Kawai S, Makino Y, Kitamura T, Iwami T. Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan). BMC Emerg Med 2022; 22:84. [PMID: 35568800 PMCID: PMC9107729 DOI: 10.1186/s12873-022-00641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background The association between spontaneous initial body temperature on hospital arrival and neurological outcomes has not been sufficiently studied in patients after out-of-hospital cardiac arrest (OHCA). Methods From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all patients with OHCA of medical origin aged > 18 years for whom resuscitation was attempted and who were transported to participating hospitals between 2012 and 2019. We excluded patients who were not witnessed by bystanders and treated by a doctor car or helicopter, which is a car/helicopter with a physician. The patients were categorized into three groups according to their temperature on hospital arrival: ≤35.9 °C, 36.0–36.9 °C (normothermia), and ≥ 37.0 °C. The primary outcome was 1-month survival, with a cerebral performance category of 1 or 2. Multivariable logistic regression analyses were performed to evaluate the association between temperature and outcomes (normothermia was used as the reference). We also assessed this association using cubic spline regression analysis. Results Of the 18,379 patients in our database, 5014 witnessed adult OHCA patients of medical origin from 16 hospitals were included. When analyzing 3318 patients, OHCA patients with an initial body temperature of ≥37.0 °C upon hospital arrival were associated with decreased favorable neurological outcomes (6.6% [19/286] odds ratio, 0.51; 95% confidence interval, 0.27–0.95) compared to patients with normothermia (16.4% [180/1100]), whereas those with an initial body temperature of ≤35.9 °C were not associated with decreased favorable neurological outcomes (11.1% [214/1932]; odds ratio, 0.78; 95% confidence interval, 0.56–1.07). The cubic regression splines demonstrated that a higher body temperature on arrival was associated with decreased favorable neurological outcomes, and a lower body temperature was not associated with decreased favorable neurological outcomes. Conclusions In adult patients with OHCA of medical origin, a higher body temperature on arrival was associated with decreased favorable neurologic outcomes.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-, Sayama, Japan
| | - Yoshiki Yagi
- Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-, Osaka, Japan
| | - Sung-Ho Kim
- Senshu Trauma and Critical Care Center, Osaka, Japan
| | - Yasuyuki Hayashi
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Haruko Sakamoto
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan
| | - Keitaro Suzuki
- Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Shunsuke Kawai
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Yuto Makino
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan, Postal code: 606-8501, YoshidaHonmachi, Sakyo, Kyoto, Japan.
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Ryu SJ, Lee DH, Lee BK, Jeung KW, Jung YH, Park JS, Min JH, Kim DK. Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C. Ther Hypothermia Temp Manag 2021; 12:74-81. [PMID: 34271840 DOI: 10.1089/ther.2021.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the association between variability in body temperature (BT) and water temperature (WT) during the maintenance period of targeted temperature management (TTM) and neurologic outcomes in out-of-hospital cardiac arrest (OHCA) survivors. Adult (≥18 years), comatose OHCA survivors who underwent TTM at 33°C between October 2015 and December 2019 were included. We collected data on BT and WT recorded every minute during the TTM maintenance period. Temperature variability was measured as the standard deviation of BT and WT during the 33°C maintenance period. The primary outcome was a poor neurologic outcome, defined as a cerebral performance category scale 3-5 at 6 months. Of the 154 included patients, 96 (62.3%) had poor outcomes. The BT variability in the poor outcome group was lower than that in the good outcome group (0.16°C [0.13-0.27°C] vs. 0.13°C [0.11-0.18°C]). In addition, the WT variability during the maintenance period in the poor outcome group was lower than that in the good outcome group (2.24°C [1.80-3.96°C] vs. 1.77°C [1.26-2.32°C]). In the multivariate analysis, WT variability (odds ratio 0.508; 95% confidence interval, 0.295-0.874; p = 0.014) was independently associated with poor neurologic outcome. BT variability and cooling beyond 33.0°C ± 1.0°C were not associated with poor neurologic outcomes. WT variability during the maintenance period was independently associated with neurologic outcomes in OHCA survivors who underwent TTM at 33°C. In addition, overcooling or undercooling during the maintenance period was not associated with neurologic outcomes.
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Affiliation(s)
- Seok Jin Ryu
- Department of Emergency Medicine, Chonnam National University, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.,Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jin Hong Min
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Dong Ki Kim
- Department of Emergency Medicine, Chonnam National University, Chonnam National University Hospital, Gwangju, Republic of Korea
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Thermal Index for early non-invasive assessment of brain injury in newborns treated with therapeutic hypothermia: preliminary report. Sci Rep 2021; 11:12578. [PMID: 34131269 PMCID: PMC8206354 DOI: 10.1038/s41598-021-92139-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.
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Walas W, Bandoła D, Ostrowski Z, Rojczyk M, Mączko A, Halaba Z, Nowak AJ. Theoretical basis for the use of non-invasive thermal measurements to assess the brain injury in newborns undergoing therapeutic hypothermia. Sci Rep 2020; 10:22167. [PMID: 33335145 PMCID: PMC7747633 DOI: 10.1038/s41598-020-79009-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this paper is to propose a new non-invasive methodology to estimate thermogenesis in newborns with perinatal asphyxia (PA) undergoing therapeutic hypothermia (TH). Metabolic heat production (with respect to either a neonate’s body mass or its body surface) is calculated from the newborn’s heat balance, estimating all remaining terms of this heat balance utilising results of only non-invasive thermal measurements. The measurement devices work with standard equipment used for therapeutic hypothermia and are equipped with the Global System for Mobile Communications (GSM), which allows one to record and monitor the course of the therapy remotely (using an internet browser) without disturbing the medical personnel. This methodology allows one to estimate thermogenesis in newborns with perinatal asphyxia undergoing therapeutic hypothermia. It also offers information about instantaneous values of the rate of cooling together with values of remaining rates of heat transfer. It also shows the trend of any changes, which are recorded during treatment. Having information about all components of the heat balance one is able to facilitate comparison of results obtained for different patients, in whom these components may differ. The proposed method can be a new tool for measuring heat balance with the possibility of offering better predictions regarding short-term neurologic outcomes and tailored management in newborns treated by TH.
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Affiliation(s)
- Wojciech Walas
- Paediatric and Neonatal Intensive Care Unit, University Clinical Hospital, Opole, Poland.,Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Dominika Bandoła
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Ziemowit Ostrowski
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Marek Rojczyk
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Anna Mączko
- Paediatric and Neonatal Intensive Care Unit, University Clinical Hospital, Opole, Poland
| | - Zenon Halaba
- Department of Paediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Andrzej J Nowak
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland.
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Increased Heat Generation in Postcardiac Arrest Patients During Targeted Temperature Management Is Associated With Better Outcomes. Crit Care Med 2019; 46:1133-1138. [PMID: 29620555 DOI: 10.1097/ccm.0000000000003154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (Ttarget) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to Ttarget and outcomes. DESIGN Retrospective cohort study. SETTING Urban tertiary-care hospital. PATIENTS Successfully resuscitated targeted temperature management-treated adult postarrest patients between 2008 and 2015 with serial temperature data and Ttarget less than or equal to 34°C. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Time to Ttarget was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation ("heat units") was calculated as inverse of average water temperature × hours between initiation and Ttarget × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3-5 generated less heat before reaching Ttarget (median, 8.1 heat units [interquartile range, 3.6-21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.3 hr [interquartile range, 1.5-4.0 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01) than patients with Cerebral Performance Category score 1-2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6-20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.2 hr [interquartile range, 1.5-3.8 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01). Controlling for average water temperature between initiation and Ttarget, the relationship between outcomes and time to Ttarget was no longer significant. Controlling for location, witnessed arrest, age, initial rhythm, and neuromuscular blockade use, increased heat generation was associated with better neurologic (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.039) and survival (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.045) outcomes. CONCLUSIONS Increased heat generation during targeted temperature management initiation is associated with better outcomes at hospital discharge and may affect the relationship between time to Ttarget and outcomes.
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Ratajczak J, Łach P, Umińska JM, Pstrągowski K, Kasprzak M, Fabiszak T, Navarese EP, Kubica J. Mild therapeutic hypothermia after out-of-hospital cardiac arrest: What does really matter? Cardiol J 2019; 28:293-301. [PMID: 30799547 DOI: 10.5603/cj.a2019.0023] [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] [Received: 01/10/2019] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mild therapeutic hypothermia (MTH) is a recommended treatment of comatose patients after out-of-hospital cardiac arrest (OHCA). The aim of the study was to examine determinants of clinical outcome in OHCA survivors treated with MTH and variables associated with MTH induction time. METHODS Presented herein is an analysis of combined results from a retrospective and a prospective observational study which included 90 OHCA survivors treated with MTH from January 2010 to March 2018. Multivariate regression analysis was performed to determine variables associated with poor neurologic outcome (Cerebral Performance Category 3-5), mortality, and prolonged induction time. RESULTS At hospital discharge, 59 (65.6%) patients were alive, of whom 36 (61%) had a good neurologic outcome. Older patients (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.12) with lower Glasgow Coma Scale (GCS) (OR 0.49, 95% CI 0.30-0.80) were at higher risk of poor neurological outcome. The predictors of in-hospital death included: older age (OR 1.08, 95% CI 1.02-1.13), lower GCS score (OR 0.47, 95% CI 0.25-0.85), presence of cardiogenic shock (OR 3.43, 95% CI 1.11-10.53), and higher doses of adrenaline (OR 1.27, 95% CI 1.04-1.56). Longer induction was associated with shorter cardio-pulmonary resuscitation (CPR) (unstandardized coefficient -3.95, 95% CI -7.09 to -0.81) and lower lactate level (unstandardized coefficient -18.55, 95% CI -36.10 to -1.01). CONCLUSIONS Unfavorable neurologic outcome in OHCA patients treated with MTH is associated with age and lower GCS score. Risk factors for in-hospital mortality include age, high-dose adrenaline administration, lower GCS score and presence of cardiogenic shock. CPR duration and lactate level were predictive of prolonged MTH induction time.
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Affiliation(s)
- Jakub Ratajczak
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland.
| | - Piotr Łach
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Julia M Umińska
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Krzysztof Pstrągowski
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Eliano Pio Navarese
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
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Moler FW, Silverstein FS, Nadkarni VM, Meert KL, Shah SH, Slomine B, Christensen J, Holubkov R, Page K, Dean JM. Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes. Resuscitation 2018; 135:88-97. [PMID: 30572071 DOI: 10.1016/j.resuscitation.2018.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/26/2018] [Accepted: 12/10/2018] [Indexed: 01/11/2023]
Abstract
AIM Although recent out-of-hospital cardiac arrest (CA) trials found no benefits of hypothermia versus normothermia targeted temperature management, preclinical models suggest earlier timing of hypothermia improves neuroprotective efficacy. This study investigated whether shorter time to goal temperature was associated with better one-year outcomes in the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial. METHODS Patients were classified by tertiles of time to attain assigned goal temperature range (32-34°C or 36-37.5°C) following ROSC. Outcomes in the first tertile ("earlier") Group 1 were compared with second and third tertiles ("later") Group 2. Separate analyses were, additionally, completed for hypothermia and normothermia intervention groups. Three one-year outcomes were examined: survival; Vineland Adaptive Behavior Scale (VABS-II) score≥70; and decrease in VABS-II≤15 points from baseline. RESULTS In the entire cohort (n=281), median time from ROSC to goal temperature was 7.4 [IQR 6.2-9.7] hours: Group 1, 5.8 [IQR 5.2, 6.2] and Group 2, 8.8 [IQR 7.4, 10.4] h. Outcomes did not differ between these groups. For hypothermia subgroup, survival was lower in Group 1 than 2, [10/49(20%) versus 47/99(47%), p<0.002], with a trend toward fewer with VABS-II scores≥70 and change in VABS-II≤15 points (p=0.07-0.08). For normothermia subgroup, there was a trend toward higher survival in Group 1 than 2 [18/42(43%) versus 21/83(25%), p=0.065], but no differences in VABS-II-related measures. In multivariable logistic regression models, no difference in earlier and later groups or temperature intervention was observed. CONCLUSION We found no evidence that earlier time to goal temperature was associated with better outcomes.
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Affiliation(s)
- Frank W Moler
- University of Michigan Medical School, Ann Arbor, MI, United States.
| | | | - Vinay M Nadkarni
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kathleen L Meert
- Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States
| | - Samir H Shah
- University of Tennessee Health Sciences Center, United States
| | - Beth Slomine
- Kennedy Krieger Institute and Johns Hopkins University, Baltimore, MD, United States
| | - James Christensen
- Kennedy Krieger Institute and Johns Hopkins University, Baltimore, MD, United States
| | | | - Kent Page
- University of Utah, Salt Lake City, UT, United States
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12
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May TL, Riker RR, Gagnon DJ, Duarte C, McCrum B, Hoover C, Seder DB. Continuous surface EMG power reflects the metabolic cost of shivering during targeted temperature management after cardiac arrest. Resuscitation 2018; 131:8-13. [DOI: 10.1016/j.resuscitation.2018.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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13
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Sarıtaş A, Çinleti BA, Zincircioğlu Ç, Uzun U, Köse I, Şenoğlu N. Effect of regional cerebral oximetry to estimate neurologic prognostic outcomes in patients administered targeted temperature management. Am J Emerg Med 2018; 36:2236-2241. [PMID: 29655502 DOI: 10.1016/j.ajem.2018.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/04/2018] [Accepted: 04/07/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The aim of our study is to research the role and efficacy of cerebral oximetry in predicting neurologic prognosis when applied during TTM to patients experiencing coma after CA. METHODS This study was performed on surviving adult comatose patients after CA treated with TTM. The average scores of rSO2 was measured at 6h intervals for the first 2days and once a day for the following 3days with a NIRS device during TTM. The CPC scale was used to define the neurologic outcomes of patients. We compared the correlations of rSO2 values between good (CPC 1-2) and poor (CPC 3-5) neurologic outcomes in CA patients. RESULTS There was no statistically significant difference identified between the prognosis groups in terms of rSO2, CPR durations, hemoglobin values and admission body temperature (p>0.05). When the variation in rSO2 values over time is investigated, though there was no significant difference between the good and poor prognosis groups, it appeared to fall in the first 6h in both prognosis groups. The median NT-proBNP and lactate values were observed to be higher in the poor prognosis group. CONCLUSION There is no significant correlation between rSO2 values and neurologic outcomes. Multimodal monitoring methods may be useful and further studies with a larger patient population are necessary in this area.
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Affiliation(s)
- Aykut Sarıtaş
- Tepecik Training and Research Hospital, Department of Anesthesiology and Reanimation İzmir, Turkey.
| | - Burcu Acar Çinleti
- Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Turkey
| | - Çiler Zincircioğlu
- Tepecik Training and Research Hospital, Department of Anesthesiology and Reanimation İzmir, Turkey
| | - Uğur Uzun
- Tepecik Training and Research Hospital, Department of Anesthesiology and Reanimation İzmir, Turkey
| | - Işıl Köse
- Tepecik Training and Research Hospital, Department of Anesthesiology and Reanimation İzmir, Turkey
| | - Nimet Şenoğlu
- Tepecik Training and Research Hospital, Department of Anesthesiology and Reanimation İzmir, Turkey
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14
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Martinell L, Nielsen N, Herlitz J, Karlsson T, Horn J, Wise MP, Undén J, Rylander C. Early predictors of poor outcome after out-of-hospital cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:96. [PMID: 28410590 PMCID: PMC5391587 DOI: 10.1186/s13054-017-1677-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/22/2017] [Indexed: 12/24/2022]
Abstract
Background Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient’s history and status at intensive care admission with outcome in unconscious survivors of OHCA. Methods Using the cohort of the Target Temperature Management trial, we performed a post hoc analysis of 933 unconscious patients with OHCA of presumed cardiac cause who had a complete 6-month follow-up. Outcomes were survival and neurological function as defined by the Cerebral Performance Category (CPC) scale at 6 months after OHCA. After multiple imputations to compensate for missing data, backward stepwise multivariable logistic regression was applied to identify factors independently predictive of a poor outcome (CPC 3–5). On the basis of these factors, a risk score for poor outcome was constructed. Results We identified ten independent predictors of a poor outcome: older age, cardiac arrest occurring at home, initial rhythm other than ventricular fibrillation/tachycardia, longer duration of no flow, longer duration of low flow, administration of adrenaline, bilateral absence of corneal and pupillary reflexes, Glasgow Coma Scale motor response 1, lower pH and a partial pressure of carbon dioxide in arterial blood value lower than 4.5 kPa at hospital admission. A risk score based on the impact of each of these variables in the model yielded a median (range) AUC of 0.842 (0.840–0.845) and good calibration. Internal validation of the score using bootstrapping yielded a median (range) AUC corrected for optimism of 0.818 (0.816–0.821). Conclusions Among variables available at admission to intensive care, we identified ten independent predictors of a poor outcome at 6 months for initial survivors of OHCA. They reflected pre-hospital circumstances (six variables) and patient status on hospital admission (four variables). By using a simple and easy-to-use risk scoring system based on these variables, patients at high risk for a poor outcome after OHCA may be identified early.
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Affiliation(s)
- Louise Martinell
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden.
| | - Niklas Nielsen
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Herlitz
- The Centre for Pre-hospital Research in Western Sweden, University College of Borås and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Johan Undén
- Department of Intensive Care and Perioperative Medicine, Lund University, Malmö, Sweden
| | - Christian Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden
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15
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Resuscitation highlights in 2016. Resuscitation 2017; 114:A1-A7. [PMID: 28212838 DOI: 10.1016/j.resuscitation.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/21/2022]
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