1
|
Cheng P, Wang H, Guo L, Wang M, Xu H, Gu P, Wu J, Yang M. Survival and neurological function in patients treated with extracorporeal membrane oxygenation and therapeutic hypothermia: a protocol for updating a systematic review. BMJ Open 2024; 14:e081207. [PMID: 38531575 PMCID: PMC10966782 DOI: 10.1136/bmjopen-2023-081207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION The widespread application of extracorporeal membrane oxygenation (ECMO) has enhanced clinical outcomes for patients experiencing cardiac arrest. However, its effectiveness is still limited and falls short of the desired level. Therapeutic hypothermia, which maintains body temperatures between 32°C and 36°C in cardiac arrest patients treated with ECMO, has been proposed as a potential means of neuroprotection and increased survival rates. Nevertheless, it remains controversial, and its impact on patient complications has yet to be fully understood. Thus, this paper aims to update the protocol for a systematic review of patients treated with ECMO and therapeutic hypothermia, in order to explore its effects on survival and neurological function. METHOD AND ANALYSIS This protocol has been developed in compliance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols 2015. The following databases will be systematically searched: PubMed, Web of Science, Cochrane Library, Embase, Ovid, CNKI, Wanfang and China Biology Medicine Disc. The database search strategy will use a combination of subject terms and free-text keywords. The search will encompass articles from the inception of each database up to 15 June 2023. Inclusion criteria encompass randomised controlled trials, cohort studies, case-control studies and quasi-experimental studies. Two researchers will independently review articles and extract relevant data based on these criteria. Any disagreements will be resolved through discussion. Data analysis will be performed using Review Manager software. ETHICS AND DISSEMINATION Since no patient data were collected in this study, ethical approval was not required. Research findings will be released in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023435353.
Collapse
Affiliation(s)
- Pengfei Cheng
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haizhen Wang
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Luyao Guo
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Meiling Wang
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - He Xu
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Peipei Gu
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinjing Wu
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Minfei Yang
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
Alcamo AM, Lavezoli R, Dezfulian C, Simon DW, Aneja RK, Clark RSB, Kochanek PM, Fink EL. Feasibility and Performance of a Gel-Adhesive Pad System for Pediatric Targeted Temperature Management: An Exploratory Analysis of 19 Pediatric Critically Ill Patients. Ther Hypothermia Temp Manag 2020; 11:19-27. [PMID: 32429750 DOI: 10.1089/ther.2020.0011] [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: 11/13/2022] Open
Abstract
Targeted temperature management (TTM) is an important treatment modality in pediatric neurocritical care. There are different types of devices available to deliver this therapy, but limited pediatric data exist. This quality improvement study evaluates the use of a surface cooling device that uses gel-adhesive pads for TTM in critically ill pediatric patients. An institutional TTM protocol to use the gel-adhesive pad system was developed with three different temperature goals: normothermia (goal temperature 37°C), mild hypothermia (goal temperature 35°C with rewarming duration of 12 hours to normothermia), and moderate hypothermia (goal temperature 33°C with rewarming duration of 24 hours to normothermia). Protocol and device implementation required several different educational sessions for all members of the critical care team. An exploratory analysis was performed for 19 patients with complete clinical and device temperature data. The most common protocol used was normothermia (73.6%). By protocol, time to goal temperature was 58 minutes (22.0-112.8) for normothermia, 46.5 minutes (44.3-48.8) for mild hypothermia, and 93 minutes (46.5-406.5) for moderate hypothermia. Patients remained within ±0.5°C temperature goal 99% (96.0-99.3) of the time in the normothermia protocol, 99.5% (99-100) in mild hypothermia, and 93% (80-100) for the moderate hypothermia protocol. Shivering was the most common adverse event (35%). Our results show that use of the gel-adhesive pad system for pediatric TTM is feasible, efficacious with regard to achieving both a short time to target temperature and maintaining temperature goal, and, in this limited sample, was free from major adverse events. We also defined several technical aspects of device use in pediatric patients that should be considered in future trial design and/or clinical use. Further studies are needed to determine if this device is superior to other cooling devices for temperature management in the pediatric population.
Collapse
Affiliation(s)
- Alicia M Alcamo
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rebecca Lavezoli
- Department of Critical Care Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cameron Dezfulian
- Department of Critical Care Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dennis W Simon
- Department of Critical Care Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rajesh K Aneja
- Department of Critical Care Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert S B Clark
- Department of Critical Care Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick M Kochanek
- Department of Critical Care Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ericka L Fink
- Department of Critical Care Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Bhatti F, Naiman M, Tsarev A, Kulstad E. Esophageal Temperature Management in Patients Suffering from Traumatic Brain Injury. Ther Hypothermia Temp Manag 2019; 9:238-242. [PMID: 30657435 PMCID: PMC6918847 DOI: 10.1089/ther.2018.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death in the United States, and represents 2.5 million Emergency Department attendances, admissions into hospital, and deaths. A range of temperature modulating devices have been used to proactively cool TBI patients; however, there are currently no uniform targeted temperature management (TTM) guidelines in this patient population. Esophageal temperature management (ETM) is a relatively new TTM modality and the purpose of this study is to determine whether ETM is effective in controlling core temperature in TBI cases. This prospective interventional trial was a single-site study that enrolled 12 patients who received a TTM protocol using ETM. Eleven out of 12 patients reached target temperature during the first 10 hours of treatment. A total of 480 temperature measurements were recorded; 85% of the total measurements were within ±1°C of target temperature (408 measurements) and 75% were within ±0.5°C of target temperature (360 measurements). The average time to target was 5.83 ± 5.01 hours (range 1–20), with an average cooling rate of 0.58°C/h (range 0.15–1.5°C/h). This prospective interventional trial supports that ETM is a feasible TTM modality for severe TBI cases. The esophageal heat transfer device used in this study demonstrated comparable or superior performance to other commercially available TTM modalities, and the low adverse event rate may offer advantages over more invasive methods with reported higher complication rates.
Collapse
Affiliation(s)
- Faraaz Bhatti
- Department of Emergency Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Melissa Naiman
- University of Illinois, Collaborative for Advanced Design, Research, and Evaluation, Chicago, Illinois
| | - Alexander Tsarev
- Department of Anesthesiology, Dnipropetrovsk Medical Academy of the Health Ministry of Ukraine, Dnipropetrovsk, Ukraine
| | - Erik Kulstad
- Department of Emergency Medicine, Southwestern Medical Centre, The University of Texas, Dallas, Texas
| |
Collapse
|
4
|
Central Hyperthermia Treated with Bromocriptine. Case Rep Neurol Med 2017; 2017:1712083. [PMID: 28348904 PMCID: PMC5350322 DOI: 10.1155/2017/1712083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/09/2017] [Accepted: 02/12/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction. Central hyperthermia is common in patients with brain injury. It typically has a rapid onset with high temperatures and marked fluctuations and responds poorly to antibiotics and antipyretics. It is also associated with worse outcomes in the brain injured patient. Recognizing this, it is important to aggressively manage it. Case Report. We report a 34-year-old male with a right thalamic hemorrhage extending to the midbrain and into the ventricles. During his admission, he developed intractable fevers with core temperatures as high as 39.3°C. Infectious workup was unremarkable. The fever persisted despite empiric antibiotics, antipyretics, and cooling wraps. Bromocriptine was started resulting in control of the central hyperthermia. The fever spikes were reduced to minor fluctuations that significantly worsened with any attempt to wean off the bromocriptine. Conclusion. Diagnosing and managing central hyperthermia can be challenging. The use of bromocriptine can be beneficial as we have reported.
Collapse
|