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Simpson R, Karamasis GV, Davies J, Pareek N, Keeble TR. MIRACLE 2 and SCAI grade identify patients for early wakening after out-of-hospital cardiac arrest: a post hoc analysis of the THAW trial. Crit Care 2023; 27:5. [PMID: 36609362 PMCID: PMC9817342 DOI: 10.1186/s13054-022-04246-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Rupert Simpson
- grid.477183.e0000 0004 0399 6982Essex Cardiothoracic Centre, MSE Trust, Basildon, SS16 5NL Essex UK ,MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex UK
| | - Grigoris V. Karamasis
- grid.477183.e0000 0004 0399 6982Essex Cardiothoracic Centre, MSE Trust, Basildon, SS16 5NL Essex UK ,grid.5216.00000 0001 2155 0800Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - John Davies
- grid.477183.e0000 0004 0399 6982Essex Cardiothoracic Centre, MSE Trust, Basildon, SS16 5NL Essex UK ,MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex UK
| | - Nilesh Pareek
- grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Failure Centre of Excellence, King’s College London, London, SE5 9NU UK
| | - Thomas R. Keeble
- grid.477183.e0000 0004 0399 6982Essex Cardiothoracic Centre, MSE Trust, Basildon, SS16 5NL Essex UK ,MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex UK
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Pareek N, Rees P, Quinn T, Vopelius-Feldt JV, Gallagher S, Mozid A, Johnson T, Gudde E, Simpson R, Glover G, Davies J, Curzen N, Keeble TR. British Cardiovascular Interventional Society Consensus Position Statement on Out-of-Hospital Cardiac Arrest 1: Pathway of Care. Interv Cardiol 2022; 17:e18. [PMID: 36644626 PMCID: PMC9820135 DOI: 10.15420/icr.2022.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) affects 80,000 patients per year in the UK; despite improvements in care, survival to discharge remains lower than 10%. NHS England and several societies recommend all resuscitated OHCA patients be directly transferred to a cardiac arrest centre (CAC). However, evidence is limited that all patients benefit from transfer to a CAC, and there are significant organisational, logistic and financial implications associated with such change in policies. Furthermore, there is significant variability in interventional cardiovascular practices for OHCA. Accordingly, the British Cardiovascular Interventional Society established a multidisciplinary group to address variability in practice and provide recommendations for the development of cardiac networks. In this position statement, we recommend: the formal establishment of dedicated CACs; a pathway of conveyance to CACs; and interventional practice to standardise our approach. Further research is needed to understand the role of CACs and which interventions benefit patients with OHCA to support wide-scale changes in networks of care across the UK.
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Affiliation(s)
- Nilesh Pareek
- King's College Hospital NHS Foundation TrustLondon, UK,School of Cardiovascular Medicine and Sciences, British Heart Failure Centre of Excellence, King's College LondonLondon, UK
| | - Paul Rees
- Barts Interventional Group, Barts Heart CentreLondon, UK,Academic Department of Military Medicine, Defence Medical ServicesLondon, UK
| | - Tom Quinn
- Emergency, Cardiovascular and Critical Care Research Group, Kingston University and St. George's, University of LondonLondon, UK
| | | | - Sean Gallagher
- Department of Cardiology, University Hospital of WalesCardiff, UK
| | - Abdul Mozid
- Leeds Teaching Hospitals NHS Foundation TrustLeeds, UK
| | - Tom Johnson
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation TrustUK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, MSE TrustBasildon, Essex, UK,Medical Technology Research Centre, Anglia Ruskin School of MedicineChelmsford, Essex, UK
| | - Rupert Simpson
- Essex Cardiothoracic Centre, MSE TrustBasildon, Essex, UK,Medical Technology Research Centre, Anglia Ruskin School of MedicineChelmsford, Essex, UK
| | - Guy Glover
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation TrustLondon, UK
| | - John Davies
- Essex Cardiothoracic Centre, MSE TrustBasildon, Essex, UK,Medical Technology Research Centre, Anglia Ruskin School of MedicineChelmsford, Essex, UK
| | - Nick Curzen
- Faculty of Medicine, University of SouthamptonSouthampton, UK,Cardiothoracic Care Group, University Hospital SouthamptonSouthampton, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, MSE TrustBasildon, Essex, UK,Medical Technology Research Centre, Anglia Ruskin School of MedicineChelmsford, Essex, UK
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Blanc A, Colin G, Cariou A, Merdji H, Grillet G, Girardie P, Coupez E, Dequin PF, Boulain T, Frat JP, Asfar P, Pichon N, Landais M, Plantefeve G, Quenot JP, Chakarian JC, Sirodot M, Legriel S, Massart N, Thevenin D, Desachy A, Delahaye A, Botoc V, Vimeux S, Martino F, Reignier J, Taccone FS, Lascarrou JB. Targeted Temperature Management After In-Hospital Cardiac Arrest: An Ancillary Analysis of Targeted Temperature Management for Cardiac Arrest With Nonshockable Rhythm Trial Data. Chest 2022; 162:356-366. [PMID: 35318006 DOI: 10.1016/j.chest.2022.02.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Targeted temperature management (TTM) currently is the only treatment with demonstrated efficacy in attenuating the harmful effects on the brain of ischemia-reperfusion injury after cardiac arrest. However, whether TTM is beneficial in the subset of patients with in-hospital cardiac arrest (IHCA) remains unclear. RESEARCH QUESTION Is TTM at 33 °C associated with better neurological outcomes after IHCA in a nonshockable rhythm compared with targeted normothermia (TN; 37 °C)? STUDY DESIGN AND METHODS We performed a post hoc analysis of data from the published Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm randomized controlled trial in 584 patients. We included the 159 patients with IHCA; 73 were randomized to 33 °C treatment and 86 were randomized to 37 °C treatment. The primary outcome was survival with a good neurologic outcome (cerebral performance category [CPC] score of 1 or 2) on day 90. Mixed multivariate adjusted logistic regression analysis was performed to determine whether survival with CPC score of 1 or 2 on day 90 was associated with type of temperature management after adjustment on baseline characteristics not balanced by randomization. RESULTS Compared with TN for 48 h, hypothermia at 33 °C for 24 h was associated with a higher percentage of patients who were alive with good neurologic outcomes on day 90 (16.4% vs 5.8%; P = .03). Day 90 mortality was not significantly different between the two groups (68.5% vs 76.7%; P = .24). By mixed multivariate analysis adjusted by Cardiac Arrest Hospital Prognosis score and circulatory shock status, hypothermia was associated significantly with good day 90 neurologic outcomes (OR, 2.40 [95% CI, 1.17-13.03]; P = .03). INTERPRETATION Hypothermia at 33 °C was associated with better day 90 neurologic outcomes after IHCA in a nonshockable rhythm compared with TN. However, the limited sample size resulted in wide CIs. Further studies of patients after cardiac arrest resulting from any cause, including IHCA, are needed.
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Affiliation(s)
- Alexiane Blanc
- Médecine Intensive Réanimation, University Hospital Center, Nantes, France
| | - Gwenhael Colin
- Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France
| | - Alain Cariou
- Paris Cardiovascular Research Center, INSERM U970, Paris, France; Medical Intensive Care Unit, Cochin University Hospital Center, Paris, France; AfterROSC Network, Cochin University Hospital Center, Paris, France
| | - Hamid Merdji
- Faculté de Médecine Université de Strasbourg (UNISTRA) and the Service de Médecine Intensive Réanimation (H. Merdji), Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, Strasbourg, France; UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Guillaume Grillet
- Medical Intensive Care Unit, South Brittany General Hospital Center, Lorient, France
| | - Patrick Girardie
- Médecine Intensive Réanimation, CHU Lille, and the Université de Lille, Faculté de Médicine, Lille, France
| | - Elisabeth Coupez
- Medical Intensive Care Unit, University Hospital Center, Clermond-Ferrand, France
| | - Pierre-François Dequin
- Medical Intensive Care Unit, University Hospital Center, Tours, France; Inserm UMR 1100-Centre d'Étude des Pathologies Respiratoires, Tours University, Tours, France
| | - Thierry Boulain
- Medical Intensive Care Unit, Regional Hospital Center, Orleans, France
| | - Jean-Pierre Frat
- Medical Intensive Care Unit, University Hospital Center, Poitiers, France; INSERM, CIC-1402, Équipe ALIVE, Poitiers, France; Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Pierre Asfar
- Medical Intensive Care Unit, University Hospital Center, Angers, France
| | - Nicolas Pichon
- AfterROSC Network, Cochin University Hospital Center, Paris, France; Service de Réanimation Polyvalente, University Hospital Center, Limoges, France; CIC 1435, University Hospital Center, Limoges, France
| | - Mickael Landais
- Medical-Surgical Intensive Care Unit, General Hospital Center, Le Mans, France
| | - Gaëtan Plantefeve
- Medical-Surgical Intensive Care Unit, General Hospital Center, Argenteuil, France
| | | | | | - Michel Sirodot
- Medical-Surgical Intensive Care Unit, General Hospital Center, Annecy, France
| | - Stéphane Legriel
- AfterROSC Network, Cochin University Hospital Center, Paris, France; Medical-Surgical Intensive Care Unit, Versailles Hospital, Versailles, France
| | - Nicolas Massart
- Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Brieuc, France
| | - Didier Thevenin
- Medical-Surgical Intensive Care Unit, General Hospital Center, Lens, France
| | - Arnaud Desachy
- Medical-Surgical Intensive Care Unit, General Hospital Center, Angouleme, France
| | - Arnaud Delahaye
- Medical-Surgical Intensive Care Unit, General Hospital Center, Rodez, France
| | - Vlad Botoc
- Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Malo, France
| | - Sylvie Vimeux
- Medical-Surgical Intensive Care Unit, General Hospital Center, Montauban, France
| | - Frederic Martino
- Medical Intensive Care Unit, University Hospital Center, Pointe-à-Pitre, France
| | - Jean Reignier
- Médecine Intensive Réanimation, University Hospital Center, Nantes, France
| | - F S Taccone
- Erasmus University Hospital, Free University of Brussels, Brussels, Belgium
| | - J B Lascarrou
- Médecine Intensive Réanimation, University Hospital Center, Nantes, France; Paris Cardiovascular Research Center, INSERM U970, Paris, France; AfterROSC Network, Cochin University Hospital Center, Paris, France.
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Granfeldt A, Andersen LW. The new era of post-resuscitation care. Resuscitation 2021; 171:98-99. [PMID: 34973343 DOI: 10.1016/j.resuscitation.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Lars W Andersen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
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