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Cho Y, Kim EN, You JS, Han M, Park YS. Association between Muscle Mass Index and Neurological Outcomes of Patients with Out-of-Hospital Cardiac Arrest. Life (Basel) 2024; 14:680. [PMID: 38929664 PMCID: PMC11204909 DOI: 10.3390/life14060680] [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: 03/25/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Muscle mass depletion is associated with unfavorable outcomes in many diseases. However, its relationship with cardiac arrest outcomes has not been explored. This retrospective single-center study determined the relationship between muscle mass depletion and the neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA) by measuring muscle mass at various locations. Adult patients with OHCA, who were treated with target temperature management, and who underwent abdominal or chest computed tomography (CT) within 3 months of the cardiac arrest were included. Skeletal muscle index (SMI) was measured at the third lumbar vertebra (L3) level, psoas muscle, fourth thoracic vertebra (T4) level, and pectoralis muscle. The Youden index was used to determine a low SMI based on sex-specific cutoff values. The outcome variables were "good neurological outcome" and "survival" at hospital discharge. Multivariable analyses revealed that patients with low T4 SMI level were significantly associated with good neurological outcomes at hospital discharge (odds ratio = 0.26, 95% confidence interval: 0.07-0.88, p = 0.036). However, no significant differences were observed between good neurological outcomes and low SMI at the L3 level and psoas and pectoralis muscles; SMIs were not associated with survival at hospital discharge. T4 level SMI depletion was inversely associated with good neurological outcomes in patients with OHCA. Thoracic muscle depletion may be crucial for predicting the neurological outcomes in patients with OHCA and further investigation in larger prospective study is warranted.
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Affiliation(s)
- Yongtak Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Emergency Medicine, Hanyang University Hospital, Seoul 04763, Republic of Korea
| | - Eung Nam Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Chaban V, de Boer E, McAdam KE, Vaage J, Mollnes TE, Nilsson PH, Pischke SE, Islam R. Escherichia coli-induced inflammatory responses are temperature-dependent in human whole blood ex vivo. Mol Immunol 2023; 157:70-77. [PMID: 37001293 DOI: 10.1016/j.molimm.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/30/2023]
Abstract
Systemic inflammatory conditions are often associated with hypothermia or hyperthermia. Therapeutic hypothermia is used in post-cardiac arrest and some other acute diseases. There is a need for more knowledge concerning the effect of various temperatures on the acute inflammatory response. The complement system plays a crucial role in initiating the inflammatory response. We hypothesized that temperatures above and below the physiologic 37 °C affect complement activation and cytokine production ex vivo. Lepirudin-anticoagulated human whole blood from 10 healthy donors was incubated in the presence or absence of Escherichia coli at different temperatures (4 °C, 12 °C, 20 °C, 33 °C, 37 °C, 39 °C, and 41 °C). Complement activation was assessed by the terminal C5b-9 complement complex (TCC) and the alternative convertase C3bBbP using ELISA. Cytokines were measured using a 27-plex assay. Granulocyte and monocyte activation was evaluated by CD11b surface expression using flow cytometry. A consistent increase in complement activation was observed with rising temperature, reaching a maximum at 41 °C, both in the absence (C3bBbP p < 0.05) and presence (C3bBbP p < 0.05 and TCC p < 0.05) of E. coli. Temperature alone did not affect cytokine production, whereas incubation with E. coli significantly increased cytokine levels of IL-1β, IL-2, IL-6, IL-8, IFN-γ, and TNF at temperatures > 20 °C. Maximum increase occurred at 39 °C. However, a consistent decrease was observed at 41 °C, significant for IL-1β (p = 0.003). Granulocyte CD11b displayed the same temperature-dependent pattern as cytokines, with a corresponding increase in endothelial cell apoptosis and necrosis. Thus, blood temperature differentially determines the degree of complement activation and cytokine release.
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Wallner B, Schenk B, Paal P, Falk M, Strapazzon G, Martini WZ, Brugger H, Fries D. Hypothermia Induced Impairment of Platelets: Assessment With Multiplate vs. ROTEM—An In Vitro Study. Front Physiol 2022; 13:852182. [PMID: 35422712 PMCID: PMC9002345 DOI: 10.3389/fphys.2022.852182] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: This experimental in vitro study aimed to identify and characterize hypothermia-associated coagulopathy and to compare changes in mild to severe hypothermia with the quantitative measurement of rotational thromboelastometry (ROTEM) and multiple-electrode aggregometry (MULTIPLATE). Methods: Whole blood samples from 18 healthy volunteers were analyzed at the target temperatures of 37, 32, 24, 18, and 13.7°C with ROTEM (ExTEM, InTEM and FibTEM) and MULTIPLATE using the arachidonic acid 0.5 mM (ASPI), thrombin receptor-activating peptide-6 32 µM (TRAP) and adenosine diphosphate 6.4 µM (ADP) tests at the corresponding incubating temperatures for coagulation assessment. Results: Compared to baseline (37°C) values ROTEM measurements of clotting time (CT) was prolonged by 98% (at 18°C), clot formation time (CFT) was prolonged by 205% and the alpha angle dropped to 76% at 13.7°C (p < 0.001). At 24.0°C CT was prolonged by 56% and CFT by 53%. Maximum clot firmness was only slightly reduced by ≤2% at 13.7°C. Platelet function measured by MULTIPLATE was reduced with decreasing temperature (p < 0.001): AUC at 13.7°C −96% (ADP), −92% (ASPI) and −91% (TRAP). Conclusion: Hypothermia impairs coagulation by prolonging coagulation clotting time and by decreasing the velocity of clot formation in ROTEM measurements. MULTIPLATE testing confirms a linear decrease in platelet function with decreasing temperatures, but ROTEM fails to adequately detect hypothermia induced impairment of platelets.
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Affiliation(s)
- Bernd Wallner
- Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- *Correspondence: Bernd Wallner,
| | | | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Wenjun Z. Martini
- US Army Institute of Surgical Research, San Antonio, TX, United States
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Dietmar Fries
- Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Lee C, Crouch A, Jha A, Adapa A, Diaz J, Pandey A, Greve J, Pipe K. Extravascular Cooling of Blood Using a Concentrated Thermoelectric Cooling Probe. J Med Device 2022. [DOI: 10.1115/1.4054003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Thermal therapies have strong potential for improving outcomes for patients suffering from cardiac arrest, neonatal hypoxic-ischemic encephalopathy, or medically refractory intracranial hypertension. We propose a novel tool to manipulate blood temperature through extravascular thermoelectric heat exchange of blood vessel walls and flowing blood. This tool is a concentrated cooling probe with several thermoelectric units combined to focus cooling at the application site. Using this tool, we aim to achieve desired levels of temperature control and potentially reduce complications associated with traditional intravascular or systemic thermal therapies. Leveraging the feedback control, speed, and reversible operation of thermoelectric cooling modules, the device can adapt to cool or heat as desired. Pre-clinical testing on rodent models confirmed rapid, significant reduction of intravenous jugular blood temperature when a prototype device was brought in contact with the left carotid artery (change in blood temperature of -4.74 ± 2.9 °C/hr and -4.29 ± 1.64 °C/hr for 0 °C and -5 °C cooling trials respectively). Declines in rectal temperature were also noted, but at lesser magnitudes than for jugular blood (0 °C: -3.09 ± 1.29 °C/hr; -5 °C: -2.04 ± 1.08), indicating proof-of-concept of thermoelectric extravascular blood cooling within a relatively localized region of the body. With further improvements in the technique, there is potential for selective organ cooling via reduction in flowing blood temperature.
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Affiliation(s)
- Connie Lee
- Mechanical Engineering, University of Michigan, Ann Arbor, MI, 2350 Hayward St, Ann Arbor, MI 48109-2125
| | - Anna Crouch
- Mechanical Engineering, University of Michigan, Ann Arbor, MI, 2350 Hayward St, Ann Arbor, MI 48109-2125; Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, 1506 Middle Drive, 312 Perkins Hall, Knoxville, TN 37996
| | - Aman Jha
- Mechanical Engineering, University of Michigan, Ann Arbor, MI; 2350 Hayward St, Ann Arbor, MI 48109-2125
| | - Arjun Adapa
- University of Michigan Medical School, Ann Arbor, MI; 1500 E Medical Center Dr, #5338, Ann Arbor, MI 48109
| | - Jose Diaz
- Division of Surgical Research, Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Medical Center North, Nashville, TN 37232
| | - Aditya Pandey
- Neurosurgery, University of Michigan, Ann Arbor, MI; 1500 E Medical Center Dr, #5338, Ann Arbor, MI 48109
| | - Joan Greve
- Biomedical Engineering, University of Michigan, Ann Arbor, MI; Democracy II, Suite 200, 6707 Democracy Blvd., Bethesda, MD 20817
| | - Kevin Pipe
- Mechanical Engineering, University of Michigan, Ann Arbor, MI; Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI; 2350 Hayward St, Ann Arbor, MI 48109-2125
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Prasitlumkum N, Cheungpasitporn W, Sato R, Chokesuwattanaskul R, Thongprayoon C, Patlolla SH, Bathini T, Mao MA, Rab ST, Kashani K, Vallabhajosyula S. Acute kidney injury and cardiac arrest in the modern era: an updated systematic review and meta-analysis. Hosp Pract (1995) 2021; 49:280-291. [PMID: 33993820 DOI: 10.1080/21548331.2021.1931234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: Acute kidney injury (AKI) is associated with higher morbidity and mortality in cardiac arrest (CA). There are limited contemporary data on the incidence and outcomes of AKI in CA.Methods: We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED, and the Cochrane from inception to November 2020. Observational studies that reported the incidence of AKI in CA survivors were included. Data from each study were combined using the random effects to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). The primary outcome was short-term mortality and secondary outcomes included long-term mortality, incidence of AKI, and use of renal replacement therapy (RRT). Subgroup and meta-regression analyses were performed to explore heterogeneity.Main results: A total of 25 observational studies comprising 8,165 patients were included. The incidence of AKI in CA survivors was 40.3% (range 32.9-47.8%). In stage 3 AKI, one-fourth of patients required RRT. AKI was associated with an increased risk of both short-term (OR 2.27 [95% CI 1.74-2.96]; p < 0.001) and long-term mortality (OR 1.51 [95% CI 1.93-3.25]; p < 0.001). Meta-regression and subgroup analyses did not suggest any effect of hypothermia on incidence of AKI.Conclusion: AKI complicates the care of 40% of CA survivors and is associated with significantly increased short- and long-term mortality.
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Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, United States
| | - Ryota Sato
- Critical Care Unit, Cleveland Clinic, Cleveland, United States
| | | | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, United States
| | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, United States
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, United States
| | - S Tanveer Rab
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, United States
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, United States.,Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, United States
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, United States
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Matsuzaki M, Matsumoto N, Nagao K, Sawano H, Yokoyama H, Tahara Y, Hase M, Shirai S, Hazui H, Arimoto H, Kashiwase K, Kasaoka S, Motomura T, Kuroda Y, Yasuga Y, Yonemoto N, Nonogi H. Impact of Induced Therapeutic Hypothermia by Intravenous Infusion of Ice-Cold Fluids After Hospital Arrival in Comatose Survivors of Out-of-Hospital Cardiac Arrest With Initial Shockable Rhythm. Circ J 2021; 85:1842-1848. [PMID: 34261843 DOI: 10.1253/circj.cj-20-0793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of in-hospital rapid cooling by intravenous ice-cold fluids for comatose survivors of out-of-hospital cardiac arrest (OHCA) is unclear.Methods and Results:From the J-PULSE-HYPO study registry, data for 248 comatose survivors with return of spontaneous circulation (ROSC) who were treated with therapeutic hypothermia (34℃ for 12-72 h) after witnessed shockable OHCA were extracted. Patients were divided into 2 groups by the median collapse-to-ROSC interval (18 min), and then into 2 groups by cooling method (rapid cooling by intravenous ice-cold fluids vs. standard cooling). The primary endpoint was favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after OHCA. In the whole cohort, the shorter collapse-to-ROSC interval group had significantly higher favorable neurological outcome than the longer collapse-to-ROSC interval group (78.2% vs. 46.8%, P<0.001). In the shorter collapse-to-ROSC interval group, no significant difference was observed in favorable neurological outcome between the 2 cooling groups (rapid cooling group: 79.4% vs. standard cooling group: 77.0%, P=0.75). In the longer collapse-to-ROSC interval group, however, favorable neurological outcome was significant higher in the rapid cooling group than in the standard cooling group (60.7% vs. 33.3%, P<0.01) and the adjusted odds ratio after rapid cooling was 3.069 (95% confidence interval 1.423-6.616, P=0.004). CONCLUSIONS In-hospital rapid cooling by intravenous ice-cold fluids improved neurologically intact survival in comatose survivors whose collapse-to-ROSC interval was delayed over 18 min after shockable OHCA.
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Affiliation(s)
| | | | - Ken Nagao
- Department of Cardiology, Nihon University Hospital
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Saiseikai Senri Hospital
| | | | | | - Mamoru Hase
- Emergency and Critical Care Center, Sapporo City University Hospital
| | | | - Hiroshi Hazui
- Emergency Medicine, Osaka Mishima Emergency and Critical Care Center
| | - Hideki Arimoto
- Emergency and Critical Care Medical Center, Osaka City General Hospital
| | | | - Shunji Kasaoka
- Disaster Medical Education and Research Center, Kumamoto University Hospital
| | | | - Yasuhiro Kuroda
- Emergency and Critical Care Center, Kagawa University Hospital
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7
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El Sibai RH, Bachir RH, El Sayed MJ. Seasonal variation in incidence and outcomes of out of hospital cardiac arrest: A retrospective national observational study in the United States. Medicine (Baltimore) 2021; 100:e25643. [PMID: 33950942 PMCID: PMC8104224 DOI: 10.1097/md.0000000000025643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/19/2021] [Indexed: 01/04/2023] Open
Abstract
Out of hospital cardiac arrest (OHCA) remains a leading cause of mortality among adults in the United States. Environmental impact on incidence and outcomes of OHCA has not been fully investigated in recent years. Previous studies showed a possible increase in incidence and mortality in winter season and during seasons with temperature extremes. This study examines seasonal variation in incidence and outcomes of OHCA in the United States.Retrospective study of adult OHCA using the Nationwide Emergency Department Sample was carried out. Monthly incidence rate per 100,000 ED presentations was calculated. Survival rates for each month of admission were examined by hospital region. Multivariate analyses were conducted to determine the effect of the season and month of admission on survival.A total of 122,870 adult OHCA cases presented to emergency departments (EDs) in 2014 and were included. Average incidence of OHCA cases was 147 per 100,000 ED presentations. Overall survival rate in the study population was 5.6% (95% confidence intervals [CI] = 5.4%-5.9%). Patients had an average age of 65.5 (95% CI: 65.3-65.7) years and were mainly men (61.8%). Rates of OHCA presentations were highest during December and January (9.9% and 10.0%) while survival rates were lowest during December (4.6%) and highest in June (6.9%). Regional variation in OHCA outcomes was also noted with highest average survival rate in West (7.8%) and lowest in South (4.3%). After adjusting for confounders including region of hospital, Summer season (Ref: all other seasons), and more specifically month of June (Ref: all other months) were found to be positively associated with survival (OR 1.27, 95% CI [1.07-1.52], P-value = .008) and (OR 1.43, 95% CI [1.08-1.89], P-value = .012 respectively).Incidence and outcomes of out of hospital cardiac arrest presentations to the emergency departments in the United States have seasonal variation. Both incidence and mortality of OHCA increase during colder months, and survival is significantly higher in summer season or in June. Exploring how to use this variation to improve outcomes through refresher training of medical providers or through other mitigation plans is needed.
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Affiliation(s)
| | | | - Mazen J. El Sayed
- Department of Emergency Medicine
- Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon
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8
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Morris S, Keeping-Burke L, Manley A. Experiences of family members of patients treated with targeted temperature management post cardiac arrest: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:1760-1765. [PMID: 32898368 DOI: 10.11124/jbisrir-d-19-00291] [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: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to evaluate the experiences of family members of patients who receive targeted temperature management following the return of spontaneous circulation after a cardiac arrest. INTRODUCTION Since 2002, targeted temperature management has become an international standard of care for the preservation of neurological status for patients following a cardiac arrest and who remain comatose. During this process, survivors are placed into a mild hypothermic state with their body temperature maintained at 32°C to 36°C for a minimum of 24 hours. It is during this time that family members experience the uncertainty of whether their loved one will survive, or if any negative long-term sequelae will be experienced. While much is known about the physical application and management of targeted temperature management, less is known about the psychosocial aspects of this treatment. INCLUSION CRITERIA This review will consider qualitative studies that address the experiences of family members of adult patients who have received targeted temperature management following a cardiac arrest. METHODS CINAHL, ProQuest Nursing and Allied Health Source, PsycINFO, PubMed (MEDLINE), Scopus, Sociological Abstracts, and Web of Science will be searched for relevant studies. Studies published in English and French from 2002 onward will be considered. Two reviewers will independently appraise studies and extract qualitative data using the JBI standardized critical appraisal and extraction instruments. Findings from the review will be categorized according to similarity in meaning, and categories subjected to a meta-aggregation to produce a single comprehensive set of synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020142942.
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Affiliation(s)
- Susan Morris
- 1New Brunswick Heart Centre, Saint John Regional Hospital, Horizon Health Network, Saint John, Canada 2Department of Nursing & Health Sciences, University of New Brunswick, Saint John, Canada 3The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence 4Library Services, Miramichi Regional Hospital, Horizon Health Network, Miramichi, Canada
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Peluso L, Belloni I, Calabró L, Dell’Anna AM, Nobile L, Creteur J, Vincent JL, Taccone FS. Oxygen and carbon dioxide levels in patients after cardiac arrest. Resuscitation 2020; 150:1-7. [DOI: 10.1016/j.resuscitation.2020.02.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 01/26/2023]
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Kim JG, Shin H, Choi HY, Kim W, Kim J, Moon S, Kim B, Ahn C, Lee J. Prognostic factors for neurological outcomes in Korean targeted temperature management recipients with return of spontaneous circulation after out-of-hospital cardiac arrests: A nationwide observational study. Medicine (Baltimore) 2020; 99:e19581. [PMID: 32282707 PMCID: PMC7440340 DOI: 10.1097/md.0000000000019581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Targeted temperature management (TTM) is recommended for comatose patients after out-of-hospital cardiac arrests (OHCAs). Even after successful TTM, several factors could influence the neuroprotective effect of TTM. The aim of this study is to identify prognostic factors associated with good neurological outcomes in TTM recipients.This study used nationwide data during 2012 to 2016 to investigate prognostic factors associated with good neurological outcomes in patients who received TTM after the return of spontaneous circulation (ROSC). Multivariate logistic regression analysis was conducted to analyse the factors that may affect the neurological outcomes in the TTM recipients.The study included 1578 eligible patients, comprising 767 with good and 811 with poor neurological outcomes. Multivariable analyses showed that OHCA in public places (OR, 1.599; 95% CI, 1.100-2.323, P = .014), initial shockable rhythms (OR, 1.721; 95% CI, 1.191-2.486, P = .004), pre-hospital ROSCs (OR, 6.748; 95% CI, 4.703-9.682, P < .001), bystander cardiopulmonary resuscitation (CPR) (OR, 1.715; 95% CI, 1.200-2.450, P = .003), and primary coronary interventions (PCIs) (OR, 2.488; 95% CI, 1.639-3.778, P < .001) were statistically significantly associated with good neurological outcomes. Whereas, increase of age (OR, 0.962; 95% CI, 0.950-0.974, P < .001) and conventional cooling (OR, 0.478; 95% CI, 0.255-0.895, P = .021) were statistically significantly associated with poor neurological outcome.This study suggests that being younger, experiencing OHCA in public places, having initial shockable rhythm, pre-hospital ROSC, and bystander CPR, implementing PCIs and applying intravascular or surface cooling devices compared to conventional cooling method could predict good neurological outcomes in post-cardiac arrest patients who received TTM.
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Affiliation(s)
- Jae Guk Kim
- Department of Emergency Medicine, Hallym University College of Medicine
- Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri
| | - Hyun Young Choi
- Department of Emergency Medicine, Hallym University College of Medicine
| | - Wonhee Kim
- Department of Emergency Medicine, Hallym University College of Medicine
| | - Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine, Chuncheon
| | - Shinje Moon
- Department of Internal Medicine, Hallym University College of Medicine
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul
| | - Chiwon Ahn
- Department of Emergency Medicine, Armed Force Yangju Hospital, Yangju
| | - Juncheol Lee
- Department of Emergency Medicine, Armed Force Capital Hospital, Seongnam, Republic of Korea
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Koren O, Rozner E, Yosefia S, Turgeman Y. Therapeutic hypothermia after out of hospital cardiac arrest improve 1-year survival rate for selective patients. PLoS One 2020; 15:e0226956. [PMID: 31910226 PMCID: PMC6946126 DOI: 10.1371/journal.pone.0226956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Therapeutic Hypothermia (TH) is a standard of care after out-of-hospital cardiac arrest (OHCA). Previous reports failed to prove a significant benefit for survival or neurological outcomes. We examined whether the proper selection of patients would enhance treatment efficacy. Method We conducted a retrospective cohort study. Data was collected from January 2000 and August 2018. Patients were enrolled after OHCA and classified into two groups, patients treated with TH and patients who were not treated with TH. Results A total of 92 patients were included in the study. 57 (63%) patients were in the TH Group and 34 (37%) in the Non-TH group. There was no statistical difference in favorable neurological outcomes between the groups. Patients presenting with ventricular fibrillation had a higher 1-year survival rate from TH, while patients with asystole were found to benefit only if they were younger than 65 years (p < .007, p < .02, respectively). Conclusion Therapeutic Hypothermia patients failed to demonstrate a significant benefit in terms of improved neurological outcomes. Patients treated with TH following ventricular fibrillation experienced the most benefit in terms of 1-year survival, while patients who had suffered from asystole experienced a modest benefit only if they were younger than 65 years of age. Guidelines should address age and primary arrhythmia for proper treatment selection.
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Affiliation(s)
- Ofir Koren
- Heart Institute, Emek Medical Center, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ehud Rozner
- Heart Institute, Emek Medical Center, Afula, Israel
| | | | - Yoav Turgeman
- Heart Institute, Emek Medical Center, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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12
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Assis FR, Narasimhan B, Ziai W, Tandri H. From systemic to selective brain cooling - Methods in review. Brain Circ 2019; 5:179-186. [PMID: 31950093 PMCID: PMC6950511 DOI: 10.4103/bc.bc_23_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 01/14/2023] Open
Abstract
Therapeutic hypothermia (TH) remains one of the few proven neuroprotective modalities available in clinical practice today. Although targeting lower temperatures during TH seems to benefit ischemic brain cells, systemic side effects associated with global hypothermia limit its clinical applicability. Therefore, the ability to selectively reduce the temperature of the brain while minimally impacting core temperature allows for maximizing neurological benefit over systemic complications. In that scenario, selective brain cooling (SBC) has emerged as a promising modality of TH. In this report, we reviewed the general concepts of TH, from systemic to selective brain hypothermia, and explored the different cooling strategies and respective evidence, including preclinical and clinical data. SBC has been investigated in different animal models with promising results, wherein organ-specific, rapid, and deep target brain temperature managements stand out as major advantages over systemic TH. Nevertheless, procedure-related complications and adverse events still remain a concern, limiting clinical translation. Different invasive and noninvasive methods for SBC have been clinically investigated with variable results, and although adverse effects were still reported in some studies, therapies rendered overall safe profiles. Further study is needed to define the optimal technique, timing of initiation, rate and length of cooling as well as target temperature and rewarming protocols for different indications.
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Affiliation(s)
- Fabrizio R Assis
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat Narasimhan
- Department of Internal Medicine, Mount Sinai St. Lukes-Roosevelt, New York, NY, USA
| | - Wendy Ziai
- Division of Anesthesia and Neurocritical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Mattingly TK, Lownie SP. Cold blood perfusion for selective hypothermia in acute ischemic stroke. Brain Circ 2019; 5:187-194. [PMID: 31950094 PMCID: PMC6950509 DOI: 10.4103/bc.bc_17_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/28/2019] [Accepted: 11/25/2019] [Indexed: 11/04/2022] Open
Abstract
Hypothermia is the most reliably effective neuroprotectant, and yet systemic complications limit application. A large body of animal data suggests that hypothermia is effective for focal cerebral ischemia, namely acute ischemic stroke. In order to apply hypothermia effectively, a selective approach is required to maximize the effect on the brain while minimizing systemic side effects. Due to poor transferability of promising findings in rodent models to human clinical trials for neuroprotection, the focus of this review is large animal gyrencephalic models. Unlike rodent data which favor mild hypothermia, the majority of large animal studies on selective hypothermia support moderate-to-deep hypothermia (<30°C). Cold blood perfusion produces the rapid rate of temperature reduction and depth of hypothermia required to produce meaningful neuroprotection. Further studies of selective hypothermia in acute ischemic stroke require attention to duration and rate of cooling to optimize the neuroprotection offered by this technique.
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Affiliation(s)
- Thomas K Mattingly
- Department of Neurosurgery, Division of Cerebrovascular Surgery, University of Rochester, Rochester, NY, USA
| | - Stephen P Lownie
- Department of Neurosurgery, Otolaryngology and Imaging Sciences, London Health Sciences Centre, Western University, London, ON, Canada
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14
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Woo JW, Kong W, Ambhore A, Rastogi S, Poh KK, Loh PH. Isolated right ventricle infarction. Singapore Med J 2019; 60:124-129. [PMID: 30997519 DOI: 10.11622/smedj.2019026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We described two patients who were successfully resuscitated from out-of-hospital cardiac arrest. Their ECGs showed ST elevations in V1 and aVR, as well as diffuse ST depression. Their ST elevation in V1 was noted to be greater than in aVR. While one patient was found to have an occlusion of the right ventricular (RV) branch of the right coronary artery, the other was found to have an occlusion of a proximal non-dominant right coronary artery supplying the RV branch. Successful primary percutaneous coronary intervention was performed for each patient with angioplasty and implantation of a drug-eluting stent. Both patients made good physical and neurological recovery.
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Affiliation(s)
- Jia Wei Woo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Anand Ambhore
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Saurabh Rastogi
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
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15
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Lutz Y, Loewe A, Meckel S, Dössel O, Cattaneo G. Combined local hypothermia and recanalization therapy for acute ischemic stroke: Estimation of brain and systemic temperature using an energetic numerical model. J Therm Biol 2019; 84:316-322. [PMID: 31466769 DOI: 10.1016/j.jtherbio.2019.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
Local brain hypothermia is an attractive method for providing cerebral neuroprotection for ischemic stroke patients and at the same time reducing systemic side effects of cooling. In acute ischemic stroke patients with large vessel occlusion, combination with endovascular mechanical recanalization treatment could potentially allow for an alleviation of inflammatory and apoptotic pathways in the critical phase of reperfusion. The direct cooling of arterial blood by means of an intra-carotid heat exchange catheter compatible with recanalization systems is a novel promising approach. Focusing on the concept of "cold reperfusion", we developed an energetic model to calculate the rate of temperature decrease during intra-carotid cooling in case of physiological as well as decreased perfusion. Additionally, we discussed and considered the effect and biological significance of temperature decrease on resulting brain perfusion. Our model predicted a 2 °C brain temperature decrease in 8.3, 11.8 and 26.2 min at perfusion rates of 50, 30 and 10ml100g⋅min, respectively. The systemic temperature decrease - caused by the venous blood return to the main circulation - was limited to 0.5 °C in 60 min. Our results underline the potential of catheter-assisted, intracarotid blood cooling to provide a fast and selective brain temperature decrease in the phase of vessel recanalization. This method can potentially allow for a tissue hypothermia during the restoration of the physiological flow and thus a "cold reperfusion" in the setting of mechanical recanalization.
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Affiliation(s)
- Yannick Lutz
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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16
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Casillas S, Varon J, Surani S. Sequential Targeted Temperature Management: Case Report and Literature Review. Cureus 2019; 11:e5012. [PMID: 31497442 PMCID: PMC6713242 DOI: 10.7759/cureus.5012] [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] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 59-year-old gentleman with a history of nonmetastatic tonsillar malignancy and radiation chondronecrosis, who underwent targeted temperature management (TTM) in a sequential manner. The first time the patient underwent therapeutic cooling occurred after he developed a respiratory arrest followed by a cardiac arrest and prolonged hypoxemia after a diagnostic laryngoscopy. The patient was kept at 32°C for 24 hours, and 48 hours after rewarming woke up neurologically intact. However, six hours post-extubation, he suffered upper airway obstruction, followed by a prolonged cardiac arrest. Return of spontaneous circulation on this second episode was achieved after 45 minutes of resuscitation maneuvers. The patient was cooled again and kept at 32°C for 48 hours. Five days later, the patient recovered, with an intact neurologically function. This case stands out the importance of sequential TTM after repeat cardiac arrests with a return of spontaneous circulation (ROSC), demonstrating this process as a neuroprotective way of treatment.
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Affiliation(s)
| | - Joseph Varon
- Critical Care, University of Texas Health Science Center and United General Hospital, Houston, USA
| | - Salim Surani
- Internal Medicine, Texas A&M Health Science Center, Temple, USA
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17
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Mcgloughlin SA, Udy A, O'Donoghue S, Bandeshe H, Gowardman JR. Therapeutic Hypothermia following Out-Of-Hospital Cardiac Arrest (Ohca): An Audit of Compliance at a Large Australian Hospital. Anaesth Intensive Care 2019; 40:844-9. [DOI: 10.1177/0310057x1204000512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S. A. Mcgloughlin
- Department of Intensive Care, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - A. Udy
- Department of Intensive Care, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - S. O'Donoghue
- Department of Intensive Care, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - H. Bandeshe
- Department of Intensive Care, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - J. R. Gowardman
- Department of Intensive Care, Royal Brisbane Hospital, Herston, Queensland, Australia
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18
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De Rosa S, Antonelli M, Ronco C. Hypothermia and kidney: a focus on ischaemia-reperfusion injury. Nephrol Dial Transplant 2018; 32:241-247. [PMID: 28186567 DOI: 10.1093/ndt/gfw038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/03/2016] [Indexed: 01/01/2023] Open
Abstract
Cellular damage after reperfusion of ischaemic tissue is defined as ischaemia–reperfusion injury (IRI). Hypothermia is able to decrease oxygen consumption, preventing a rapid loss of mitochondrial activity. However, even though cooling can help to decrease the deleterious effects of ischaemia, the consequences are not exclusively beneficial, such that hypothermic storage is a compromise between benefits and harm. The present review details the relationship between renal IRI and hypothermia, describing the pathophysiology of IRI and hypothermic protection through experimental evidence. Although experimental models of renal IRI are a valuable tool for understanding the pathophysiology of renal ischaemia–reperfusion, the clinical transfer of experimental results has several limitations, particularly because of anatomical and physiological differences. In this review limitations of animal models but also hypothermia as a strategy to protect the kidney from IRI are discussed. We also attempt to describe three clinical scenarios where hypothermia is used in clinical settings of IRI: transplantation, deceased donors and post-cardiac arrest.
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Affiliation(s)
- Silvia De Rosa
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Anaesthesia and Intensive Care, Catholic University, Rome, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Massimo Antonelli
- Department of Anaesthesia and Intensive Care, Catholic University, Rome, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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19
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Xu J, Hee L, Hopkins A, Juergens CP, Lo S, French JK, Mussap CJ. Clinical and Angiographic Predictors of Mortality in Sudden Cardiac Arrest Patients Having Cardiac Catheterisation: A Single Centre Registry. Heart Lung Circ 2018; 28:370-378. [PMID: 29459218 DOI: 10.1016/j.hlc.2018.01.005] [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: 10/07/2017] [Revised: 12/21/2017] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immediate cardiac catheterisation (CC) is recommended in ST-elevation myocardial infarction (STEMI) following sudden cardiac arrest (SCA). Guidelines advise urgent CC for SCA patients without-STEMI, at clinician discretion. We examined the clinical and angiographic factors predicting mortality in SCA patients having CC. METHODS Consecutive SCA patients having CC at Liverpool Hospital, Sydney (January 2011-September 2015) were retrospectively analysed. Patient data were retrieved from hospital records, and angiographic SYNTAX scores (SS) were quantified online. Independent predictors of mortality were derived using multivariate logistic analysis. RESULTS The study cohort comprised 104 SCA patients; mean age 61±12years, and 79% male. Immediate CC (<2hours post-SCA) was performed in 35% overall. Compared to the without-STEMI subgroup, STEMI patients had more ventricular fibrillation (91 vs 50%; p<0.0001), and higher mean peak serum high-sensitivity troponin-T (8.25±14.7 vs 1.97±6.13 ug/L; p=0.006); in the context of higher median SS (18 vs 6.5; p=0.002) and target-lesion SS (tSS, 10 vs 0; p<0.001). Percutaneous coronary intervention (PCI; 75 vs 23%; p<0.0001) and target vessel revascularisation (11 vs 0%; p=0.005) were more frequent for STEMI. All-cause mortality was 39%, at 1.3±1.5years follow-up. Independent mortality predictors were: delayed CC (HR 4.08), serum lactate >7mmol/L (HR 3.47), and tSS (HR 1.05). CONCLUSIONS Elevated serum lactate, tSS, and delayed CC, were predictive of longer-term mortality in SCA patients having CC. Late CC in patients without-STEMI suggest scope for improvement in real-world systems of care. Closer scrutiny of target lesion complexity may aid prognostication in SCA survivors.
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Affiliation(s)
- James Xu
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Leia Hee
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Andrew Hopkins
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Craig P Juergens
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Sidney Lo
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - John K French
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia
| | - Christian J Mussap
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
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20
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De Rosa S, De Cal M, Joannidis M, Villa G, Pacheco JLS, Virzì GM, Samoni S, D'ippoliti F, Marcante S, Visconti F, Lampariello A, Zannato M, Marafon S, Bonato R, Ronco C. The effect of whole-body cooling on renal function in post-cardiac arrest patients. BMC Nephrol 2017; 18:376. [PMID: 29284424 PMCID: PMC5747082 DOI: 10.1186/s12882-017-0780-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 12/07/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Silvia De Rosa
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy. .,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy. .,Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy.
| | - Massimo De Cal
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Gianluca Villa
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Health Science, Section of Anaesthesiology and Intensive Care, University of Florence, Florence, Italy
| | | | - Grazia Maria Virzì
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
| | - Sara Samoni
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Fiorella D'ippoliti
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Stefano Marcante
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Federico Visconti
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Antonella Lampariello
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Marina Zannato
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Silvio Marafon
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Raffaele Bonato
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
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21
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Tsai LH, Chen CB, Liu PH, Chaou CH, Huang CH, Kuo CW, Lin CC, Wang KC, Weng YM, Chien CY. Significance of blood pH value and automated external defibrillator shock in determining the outcomes of out-of-hospital cardiac arrest patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917749480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The prognosis of out-of-hospital cardiac arrest is generally poor. It is known that the survival of out-of-hospital cardiac arrest patients depends on treatments delivered in a very short time frame. Identifying outcome-associated factors may provide valuable information for decision-making in clinical practices. Aim: The objective of the present study was to assess the associations between various factors (e.g. serum biomarker levels and prehospital factors) and outcomes in adult, non-traumatic out-of-hospital cardiac arrest patients. Methods: Data from 386 consecutive out-of-hospital cardiac arrest patients treated from January 2012 to December 2015 at Taoyuan Chang Gung Memorial Hospital (Taiwan, ROC) were collected. While performing cardiopulmonary resuscitation in the emergency room, the levels of creatinine, aspartate aminotransferase, sodium, potassium, troponin-I, hydrogen bicarbonate and haemoglobin were determined, blood pH and pCO2 were measured and the white blood cell count was calculated. The response time and scene time interval were also recorded. Results: Here we found that out-of-hospital cardiac arrest patients with blood pH values of <7.34 had a lower chance of survival to 24 h (Odds Ratio (OR) = 2.77), survival to discharge (OR = 7.06) and a good neurological outcome (OR = 64.59). Moreover, patients without an automated external defibrillator shock had a lower chance of being discharged (OR = 4.27) and enjoying good neurological outcomes (OR = 25.09). Conclusion: Our data suggest that the blood pH and an automated external defibrillator shockable rhythm are two easily measurable factors strongly associated with the outcomes of out-of-hospital cardiac arrest patients.
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Affiliation(s)
- Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
| | - Kuo-Cheng Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
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22
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Cobas MA, Vera-Arroyo A. Hypothermia: Update on Risks and Therapeutic and Prophylactic Applications. Adv Anesth 2017; 35:25-45. [PMID: 29103575 DOI: 10.1016/j.aan.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Miguel A Cobas
- Department of Anesthesiology and Perioperative Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Arnaldo Vera-Arroyo
- Department of Anesthesiology and Perioperative Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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23
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Collis J. Therapeutic hypothermia in acute traumatic spinal cord injury. J ROY ARMY MED CORPS 2017; 164:214-220. [PMID: 29025962 DOI: 10.1136/jramc-2017-000792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/29/2017] [Accepted: 08/11/2017] [Indexed: 01/21/2023]
Abstract
Therapeutic hypothermia is already widely acknowledged as an effective neuroprotective intervention, especially within the acute care setting in relation to conditions such as cardiac arrest and neonatal encephalopathy. Its multifactorial mechanisms of action, including lowering metabolic rate and reducing acute inflammatory cellular processes, ultimately provide protection for central nervous tissue from continuing injury following ischaemic or traumatic insult. Its clinical application within acute traumatic spinal cord injury would therefore seem very plausible, it having the potential to combat the pathophysiological secondary injury processes that can develop in the proceeding hours to days following the initial injury. As such it could offer invaluable assistance to lessen subsequent sensory, motor and autonomic dysfunction for an individual affected by this devastating condition. Yet research surrounding this intervention's applicability in this field is somewhat lacking, the majority being experimental. Despite a recent resurgence of interest, which in turn has produced encouraging results, there is a real possibility that this potentially transformational intervention for treating traumatic spinal cord injury could remain an experimental therapy and never reach clinical implementation.
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Affiliation(s)
- James Collis
- Acute/Emergency Medicine, St Richards Hospital, Western Sussex Hospitals NHS Trust, Chichester, West Sussex PO19 6SE, UK
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24
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Nürnberger A, Herkner H, Sterz F, Olsen JA, Lozano M, van Grunsven PM, Lerner EB, Persse D, Malzer R, Brouwer MA, Westfall M, Souders CM, Travis DT, Herken UR, Wik L. Observed survival benefit of mild therapeutic hypothermia reanalysing the Circulation Improving Resuscitation Care trial. Eur J Clin Invest 2017; 47:439-446. [PMID: 28407232 PMCID: PMC5488218 DOI: 10.1111/eci.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 04/10/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mild therapeutic hypothermia is argued being beneficial for outcome after cardiac arrest. MATERIALS AND METHODS Retrospective analysis of Circulation Improving Resuscitation Care (CIRC) trial data to assess if therapeutic cooling to 33 ± 1 °C core temperature had an association with survival. Of 4231 adult, out-of-hospital cardiac arrests of presumed cardiac origin initially enrolled, eligibility criteria for therapeutic hypothermia were met by 1812. Logistic regression was undertaken in a stepwise fashion to account for the impact on outcome of each significant difference and for the variable of interest between the groups. RESULTS Out-of- and in-hospital cooled were 263 (15%), only after admission cooled were 230 (13%) and not cooled were 357 (20%) patients. The group cooled out of- and in hospital had 98 (37%) survivors as compared to the groups cooled in hospital only [80 (35%)] and of those not cooled [68 (19%)]. After adjusting for known covariates (sex, age, witnessed cardiac arrest, no- and low-flow time, shockable initial rhythm, random allocation, bystander cardiopulmonary resuscitation and percutaneous coronary intervention), the odds ratio for survival comparing no cooling to out-of- plus in-hospital cooling was 0·53 [95% confidence interval (CI): 0·46-0·61, P < 0·001], and comparing to in-hospital cooling only was 0·67 (95% CI: 0·50-0·89, P = 0·006). CONCLUSION Mild therapeutic hypothermia initiated out of hospital and/or in hospital was associated with improved survival within this secondary analysis of the CIRC cohort compared to no therapeutic hypothermia.
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Affiliation(s)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Jan-Aage Olsen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Michael Lozano
- Hillsborough County Fire Rescue, Hillsborough County Government, Tampa, FL, USA.,Department of Emergency Medicine, Lake Erie College, Bradenton, FL, USA
| | | | - E Brooke Lerner
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David Persse
- Houston Fire Department and the Baylor College of Medicine, Houston, TX, USA
| | - Reinhard Malzer
- Wiener Rettung, Municipal Ambulance Service of Vienna, Wien, Austria
| | - Marc A Brouwer
- Department of Cardiology, Heart Lung Center, GA Nijmegen, the Netherlands
| | - Mark Westfall
- Gold Cross Ambulance Service, Appleton Neenah-Menasha and Grand Chute Fire Departments, Grand Chute, WI, USA.,Theda Clark Regional Medical Center, Neenah, WI, USA
| | - Chris M Souders
- Houston Fire Department and the Baylor College of Medicine, Houston, TX, USA
| | - David T Travis
- Hillsborough County Fire Rescue, Hillsborough County Government, Tampa, FL, USA
| | | | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway
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25
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Tan PMS, Teo EYN, Ali NB, Ang BCH, Iskandar I, Law LYL, Lee JKW. Evaluation of Various Cooling Systems After Exercise-Induced Hyperthermia. J Athl Train 2017; 52:108-116. [PMID: 28156130 DOI: 10.4085/1062-6050-52.1.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Rapid diagnosis and expeditious cooling of individuals with exertional heat stroke is paramount for survival. OBJECTIVE To evaluate the efficacy of various cooling systems after exercise-induced hyperthermia. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-two men (age = 24 ± 2 years, height = 1.76 ± 0.07 m, mass = 70.7 ± 9.5 kg) participated. INTERVENTION(S) Each participant completed a treadmill walk until body core temperature reached 39.50°C. The treadmill walk was performed at 5.3 km/h on an 8.5% incline for 50 minutes and then at 5.0 km/h until the end of exercise. Each participant experienced 4 cooling phases in a randomized, repeated-crossover design: (1) no cooling (CON), (2) body-cooling unit (BCU), (3) EMCOOLS Flex.Pad (EC), and (4) ThermoSuit (TS). Cooling continued for 30 minutes or until body core temperature reached 38.00°C, whichever occurred earlier. MAIN OUTCOME MEASURE(S) Body core temperature (obtained via an ingestible telemetric temperature sensor) and heart rate were measured continuously during the exercise and cooling phases. Rating of perceived exertion was monitored every 5 minutes during the exercise phase and thermal sensation every minute during the cooling phase. RESULTS The absolute cooling rate was greatest with TS (0.16°C/min ± 0.06°C/min) followed by EC (0.12°C/min ± 0.04°C/min), BCU (0.09°C/min ± 0.06°C/min), and CON (0.06°C/min ± 0.02°C/min; P < .001). The TS offered a greater cooling rate than all other cooling modalities in this study, whereas EC offered a greater cooling rate than both CON and BCU (P < .0083 for all). Effect-size calculations, however, showed that EC and BCU were not clinically different. CONCLUSION These findings provide objective evidence for selecting the most effective cooling system of those we evaluated for cooling individuals with exercise-induced hyperthermia. Nevertheless, factors other than cooling efficacy need to be considered when selecting an appropriate cooling system.
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Affiliation(s)
- Pearl M S Tan
- Combat Protection and Performance, Defence Medical and Environmental Research Institute, Singapore
| | - Eunice Y N Teo
- Combat Protection and Performance, Defence Medical and Environmental Research Institute, Singapore
| | | | - Bryan C H Ang
- Soldier Performance Centre, Singapore Armed Forces.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Lydia Y L Law
- Combat Protection and Performance, Defence Medical and Environmental Research Institute, Singapore
| | - Jason K W Lee
- Combat Protection and Performance, Defence Medical and Environmental Research Institute, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Mulder M, Geocadin RG. Neurology of cardiopulmonary resuscitation. HANDBOOK OF CLINICAL NEUROLOGY 2017; 141:593-617. [PMID: 28190437 DOI: 10.1016/b978-0-444-63599-0.00032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This chapter aims to provide an up-to-date review of the science and clinical practice pertaining to neurologic injury after successful cardiopulmonary resuscitation. The past two decades have seen a major shift in the science and practice of cardiopulmonary resuscitation, with a major emphasis on postresuscitation neurologic care. This chapter provides a nuanced and thoughtful historic and bench-to-bedside overview of the neurologic aspects of cardiopulmonary resuscitation. A particular emphasis is made on the anatomy and pathophysiology of hypoxic-ischemic encephalopathy, up-to-date management of survivors of cardiopulmonary resuscitation, and a careful discussion on neurologic outcome prediction. Guidance to practice evidence-based clinical care when able and thoughtful, pragmatic suggestions for care where evidence is lacking are also provided. This chapter serves as both a useful clinical guide and an updated, thorough, and state-of-the-art reference on the topic for advanced students and experienced practitioners in the field.
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Affiliation(s)
- M Mulder
- Department of Critical Care and the John Nasseff Neuroscience Institute, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, USA
| | - R G Geocadin
- Neurosciences Critical Care Division, Department of Anesthesiology and Critical Care Medicine and Departments of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Utilization of palliative care services for cardiac arrest patients undergoing therapeutic hypothermia: A retrospective analysis. Resuscitation 2016; 112:22-27. [PMID: 28011292 DOI: 10.1016/j.resuscitation.2016.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/30/2016] [Accepted: 12/09/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Palliative care (PC) services are integral to the care of patients with advanced medical illnesses. Given the significant morbidity and mortality associated with cardiac arrest, we sought to measure the use and impact of PC in the care of patients treated with therapeutic hypothermia (TH). METHODS We conducted a retrospective study of 317 consecutive patients undergoing TH after cardiac arrest. We compared intensive care unit (ICU) characteristics and clinical outcomes of subjects who received PC consultation (n=125) to those who did not (n=192). RESULTS The proportion of TH patients with PC consultations increased to greater than 60% by 2013, corresponding to our institution's expansion of PC services, development of a dedicated PC unit, and integration of this service into our published TH protocol. In the TH population, time to return of spontaneous circulation (ROSC) was associated with higher inpatient mortality (p<0.001) and placement of a PC consult (p=0.011). TH patients who received PC consultation had longer ICU stays (p=0.034), more ventilator days (p<0.001), and higher inpatient mortality (p<0.001). When these measures were analyzed cohort-wide comparing all TH patients pre- and post-2013, at which time the frequency of PC consultation had dramatically increased, there were no statistically significant differences in ICU care or outcomes. CONCLUSION In our population of cardiac arrest patients undergoing TH, the utilization of PC services has increased over time, particularly for those patients with high morbidity and mortality. Future randomized studies may further delineate optimal patient selection for PC consultation to better facilitate goals of care discussions and timely medical decision-making.
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Remote Postconditioning Alone and Combined with Hypothermia Improved Postresuscitation Cardiac and Neurological Outcomes in Swine. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6743648. [PMID: 28097144 PMCID: PMC5206419 DOI: 10.1155/2016/6743648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022]
Abstract
Objective. Previously, we demonstrated that remote ischemic postconditioning (RIpostC) improved postresuscitation myocardial and cerebral functions in rat. Here, we investigated the effects of RIpostC alone and combined with therapeutic hypothermia (TH) on cardiac and neurological outcomes after CPR in swine. Methods. Twenty-one pigs were subjected to 10 mins of VF and then 5 mins of CPR. The animals were randomized to receive RIpostC alone, or its combination with TH, or sham control. RIpostC was induced by 4 cycles of limb ischemia followed by reperfusion. TH was implemented by surface cooling to reach a temperature of 32–34°C. Results. During 72 hrs after resuscitation, lower level of cardiac troponin I and greater stroke volume and global ejection fraction were observed in animals that received RIpostC when compared to the control. RIpostC also decreased serum levels of neuron-specific enolase and S100B and increased neurologic alertness score after resuscitation. The combination of RIpostC and TH resulted in greater improvement in cardiac and neurological outcomes than RIpostC alone. Conclusion. RIpostC was conducive to improving postresuscitation myocardial and cerebral functions and reducing their organ injuries. Its combination with TH further enhanced its protective effects.
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Song L, Wei L, Zhang L, Lu Y, Wang K, Li Y. The Role of Targeted Temperature Management in Adult Patients Resuscitated from Nonshockable Cardiac Arrests: An Updated Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2350974. [PMID: 27847808 PMCID: PMC5099489 DOI: 10.1155/2016/2350974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/04/2016] [Accepted: 09/27/2016] [Indexed: 01/08/2023]
Abstract
Routine targeted temperature management is recommended for comatose adult patients with return of spontaneous circulation after cardiac arrest. However, the role of targeted temperature management in patients resuscitated from nonshockable cardiac arrests remains uncertain. We conducted an updated systematic review and meta-analysis to evaluate the effects of targeted temperature management in this population. Medline, EMBASE, and Cochrane databases were systematically reviewed for studies published between January 2005 and March 2016, in which targeted temperature management was compared with standard care or normothermia for adult patients resuscitated from nonshockable cardiac arrests. A total of 25 trials that included 5715 patients were identified from 10985 relevant papers. Pooled data showed that targeted temperature management not only associated with improved short-term survival (RR = 1.42, 95% CI: 1.28-1.57) and neurological function (RR = 1.63, 95% CI: 1.39-1.91) but also associated with improved long-term survival (RR = 1.64, 95% CI: 1.27-2.12) and neurological recovery (RR = 1.42, 95% CI: 1.07-1.90) in observational cohort studies. However, more frequent infectious complications were reported in hypothermia-treated patients (RR = 1.46, 95% CI: 1.26-1.70) and the quality of the evidence ranged from moderate to very low.
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Affiliation(s)
- Lijuan Song
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Liang Wei
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Lei Zhang
- Emergency Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yubao Lu
- Emergency Department, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Kaifa Wang
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Yongqin Li
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
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Sulzgruber P, Sterz F, Schober A, Uray T, Van Tulder R, Hubner P, Wallmüller C, El-Tattan D, Graf N, Ruzicka G, Schriefl C, Zajicek A, Buchinger A, Koller L, Laggner AN, Spiel A. Editor’s Choice-Progress in the chain of survival and its impact on outcomes of patients admitted to a specialized high-volume cardiac arrest center during the past two decades. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:3-12. [DOI: 10.1177/2048872615620904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Andreas Schober
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Thomas Uray
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Diana El-Tattan
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Nikolaus Graf
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Gerhard Ruzicka
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | | | | | - Lorenz Koller
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Anton N Laggner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Alexander Spiel
- Department of Emergency Medicine, Medical University of Vienna, Austria
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Worthington H, Pickett W, Morrison LJ, Scales DC, Zhan C, Lin S, Dorian P, Dainty KN, Ferguson ND, Brooks SC. The impact of hospital experience with out-of-hospital cardiac arrest patients on post cardiac arrest care. Resuscitation 2016; 110:169-175. [PMID: 27658654 DOI: 10.1016/j.resuscitation.2016.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patient volume as a surrogate for institutional experience has been associated with quality of care indicators for a variety of illnesses. We evaluated the association between hospital experience with comatose out-of-hospital cardiac arrest (OHCA) patients and important care processes. METHODS This was a population-based, retrospective cohort study using data from 37 hospitals in Southern Ontario from 2007 to 2013. We included adults with atraumatic OHCA who were comatose on emergency department arrival and survived at least 6h. We excluded patients with a Do-Not-Resuscitate order or severe bleeding within 6h of hospital arrival. Multi-level logistic regression models estimated the association between average annual hospital volume of OHCA patients and outcomes. The primary outcome was successful targeted temperature management (TTM) and secondary outcomes included TTM initiation, premature withdrawal of life-sustaining therapy, and survival with good neurologic function. RESULTS Our analysis included 2723 patients. For every increase of 10 in the average annual volume of eligible patients, the adjusted odds increased by 30% for successful TTM (OR 1.29, 95% CI 1.03-1.62) and by 38% for initiating TTM (OR 1.38, 95% CI 1.11-1.72). No significant association between patient volume and other secondary outcomes was observed. CONCLUSIONS Patients arriving at hospitals with more experience treating comatose post cardiac arrest patients are more likely to have TTM initiated and to successfully reach target temperature. Our findings have implications for regional systems of care and knowledge translation efforts aiming to improve quality of care for this patient population.
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Affiliation(s)
- Heather Worthington
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Will Pickett
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Damon C Scales
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Chun Zhan
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Steve Lin
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Paul Dorian
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Katie N Dainty
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Niall D Ferguson
- Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Division of Respirology, Toronto General Research Institute, University Health Network and Mount Sinai Hospital, Toronto, Canada; Departments of Medicine and Physiology, Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
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Liu P, Yang R, Zuo Z. Application of a novel rectal cooling device in hypothermia therapy after cerebral hypoxia-ischemia in rats. BMC Anesthesiol 2016; 16:77. [PMID: 27613331 PMCID: PMC5017120 DOI: 10.1186/s12871-016-0239-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/24/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A new rectal cooling device for therapeutic hypothermia (TH) therapy is designed and is applied in TH treatment of SD rats with ischemic-hypoxic brain damage. METHODS Healthy adult SD rats (n = 45) were randomly assigned into four groups: the healthy control group (n = 5), the ischemia and hypoxia group (n = 10), the rectal TH cooling group (n = 18), and the ice blanket TH cooling group (n = 11). The rats in the rectal cooling and ice blanket TH groups received 12 h treatment after hypoxic-ischemic brain damage had been established, while those in the ischemia and hypoxia group did not. Taking the start of TH as the zero point, rats were sacrificed after 24 h and the brain and rectum tissues were sampled for histological analysis. RESULTS The TH induction time (37.3 ± 14.7 min) in the rectal cooling group was significantly shorter (F = 4.937, P < 0.05) than that in the ice blanket cooling group (75.6 ± 27.2 min). The HE and NISSL staining results showed that rats in the rectal TH cooling group had significantly decreased (P < 0.01) positive neurons cell count compared to those in ischemia and hypoxia group. In addition, TUNEL staining indicated that the number of apoptotic cells (3.9 ± 1.8 cells / × 400 field) and the apoptosis index (4.4 % ± 1.5) were significantly lower in rectal TH cooling group (P < 0.05) than in ischemia and hypoxia group (23.2 ± 12.1 cells / × 400 field, 26.6 % ± 12.1). Also, no rectal frostbite or inflammatory infiltration was observed in rats in the rectal TH treatment groups. CONCLUSION Our new cooling device realized rapid TH induction in SD rats with ischemic-hypoxic brain damage, inhibited the apoptosis of cells in the hippocampal CAl region, and did not cause histological damage to the rectal tissues.
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Affiliation(s)
- Peng Liu
- Department of PICU, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014 China
| | - Rui Yang
- Department of PICU, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
| | - Zelan Zuo
- Department of PICU, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
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Howard R, Eriksson S, Hirsch N, Kitchen N, Kullmann D, Taylor C, Walker M. Disorders of Consciousness, Intensive Care Neurology and Sleep. Neurology 2016. [DOI: 10.1002/9781118486160.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kim LK, Looser P, Swaminathan RV, Horowitz J, Friedman O, Shin JH, Minutello RM, Bergman G, Singh H, Wong SC, Feldman DN. Sex-Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003-2012. J Am Heart Assoc 2016; 5:e003704. [PMID: 27333880 PMCID: PMC4937290 DOI: 10.1161/jaha.116.003704] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have shown improving survival after cardiac arrest. However, data regarding sex-based disparities in treatment and outcomes after cardiac arrest are limited. METHODS AND RESULTS We performed a retrospective analysis of all patients suffering cardiac arrest between 2003 and 2012 using the Nationwide Inpatient Sample database. Annual rates of cardiac arrest, rates of utilization of coronary angiography/percutaneous coronary interventions/targeted temperature management, and sex-based outcomes after cardiac arrest were examined. Among a total of 1 436 052 discharge records analyzed for cardiac arrest patients, 45.4% (n=651 745) were females. Women were less likely to present with ventricular tachycardia/ventricular fibrillation arrests compared with men throughout the study period. The annual rates of cardiac arrests have increased from 2003 to 2012 by 14.0% (Ptrend<0.001) and ventricular tachycardia/ventricular fibrillation arrests have increased by 25.9% (Ptrend<0.001). Women were less likely to undergo coronary angiography, percutaneous coronary interventions, or targeted temperature management in both ventricular tachycardia/ventricular fibrillation and pulseless electrical activity/asystole arrests. Over a 10-year study period, there was a significant decrease in in-hospital mortality in women (from 69.1% to 60.9%, Ptrend<0.001) and men (from 67.2% to 58.6%, Ptrend<0.001) after cardiac arrest. In-hospital mortality was significantly higher in women compared with men (64.0% versus 61.4%; adjusted odds ratio 1.02, P<0.001), particularly in the ventricular tachycardia/ventricular fibrillation arrest cohort (49.4% versus 45.6%; adjusted odds ratio 1.11, P<0.001). CONCLUSIONS Women presenting with cardiac arrests are less likely to undergo therapeutic procedures, including coronary angiography, percutaneous coronary interventions, and targeted temperature management. Despite trends in improving survival after cardiac arrest over 10 years, women continue to have higher in-hospital mortality when compared with men.
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Affiliation(s)
- Luke K Kim
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Patrick Looser
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Rajesh V Swaminathan
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - James Horowitz
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Oren Friedman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Ji Hae Shin
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Robert M Minutello
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Geoffrey Bergman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Harsimran Singh
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - S Chiu Wong
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
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Cardiac arrest triggers hippocampal neuronal death through autophagic and apoptotic pathways. Sci Rep 2016; 6:27642. [PMID: 27273382 PMCID: PMC4897701 DOI: 10.1038/srep27642] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/19/2016] [Indexed: 12/31/2022] Open
Abstract
The mechanism of neuronal death induced by ischemic injury remains unknown. We investigated whether autophagy and p53 signaling played a role in the apoptosis of hippocampal neurons following global cerebral ischemia-reperfusion (I/R) injury, in a rat model of 8-min asphyxial cardiac arrest (CA) and resuscitation. Increased autophagosome numbers, expression of lysosomal cathepsin B, cathepsin D, Beclin-1, and microtubule-associated protein light chain 3 (LC3) suggested autophagy in hippocampal cells. The expression of tumor suppressor protein 53 (p53) and its target genes: Bax, p53-upregulated modulator of apoptosis (PUMA), and damage-regulated autophagy modulator (DRAM) were upregulated following CA. The p53-specific inhibitor pifithrin-α (PFT-α) significantly reduced the expression of pro-apoptotic proteins (Bax and PUMA) and autophagic proteins (LC3-II and DRAM) that generally increase following CA. PFT-α also reduced hippocampal neuronal damage following CA. Similarly, 3-methyladenine (3-MA), which inhibits autophagy and bafilomycin A1 (BFA), which inhibits lysosomes, significantly inhibited hippocampal neuronal damage after CA. These results indicate that CA affects both autophagy and apoptosis, partially mediated by p53. Autophagy plays a significant role in hippocampal neuronal death induced by cerebral I/R following asphyxial-CA.
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Arrich J, Holzer M, Havel C, Müllner M, Herkner H. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev 2016; 2:CD004128. [PMID: 26878327 PMCID: PMC6516972 DOI: 10.1002/14651858.cd004128.pub4] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Good neurological outcome after cardiac arrest is difficult to achieve. Interventions during the resuscitation phase and treatment within the first hours after the event are critical. Experimental evidence suggests that therapeutic hypothermia is beneficial, and several clinical studies on this topic have been published. This review was originally published in 2009; updated versions were published in 2012 and 2016. OBJECTIVES We aimed to perform a systematic review and meta-analysis to assess the influence of therapeutic hypothermia after cardiac arrest on neurological outcome, survival and adverse events. SEARCH METHODS We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10); MEDLINE (1971 to May 2015); EMBASE (1987 to May 2015); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1988 to May 2015); and BIOSIS (1989 to May 2015). We contacted experts in the field to ask for information on ongoing, unpublished or published trials on this topic.The original search was performed in January 2007. SELECTION CRITERIA We included all randomized controlled trials (RCTs) conducted to assess the effectiveness of therapeutic hypothermia in participants after cardiac arrest, without language restrictions. We restricted studies to adult populations cooled by any cooling method, applied within six hours of cardiac arrest. DATA COLLECTION AND ANALYSIS We entered validity measures, interventions, outcomes and additional baseline variables into a database. Meta-analysis was performed only for a subset of comparable studies with negligible heterogeneity. We assessed the quality of the evidence by using standard methodological procedures as expected by Cochrane and incorporated the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS We found six RCTs (1412 participants overall) conducted to evaluate the effects of therapeutic hypothermia - five on neurological outcome and survival, one on only neurological outcome. The quality of the included studies was generally moderate, and risk of bias was low in three out of six studies. When we compared conventional cooling methods versus no cooling (four trials; 437 participants), we found that participants in the conventional cooling group were more likely to reach a favourable neurological outcome (risk ratio (RR) 1.94, 95% confidence interval (CI) 1.18 to 3.21). The quality of the evidence was moderate.Across all studies that used conventional cooling methods rather than no cooling (three studies; 383 participants), we found a 30% survival benefit (RR 1.32, 95% CI 1.10 to 1.65). The quality of the evidence was moderate.Across all studies, the incidence of pneumonia (RR 1.15, 95% CI 1.02 to 1.30; two trials; 1205 participants) and hypokalaemia (RR 1.38, 95% CI 1.03 to 1.84; two trials; 975 participants) was slightly increased among participants receiving therapeutic hypothermia, and we observed no significant differences in reported adverse events between hypothermia and control groups. Overall the quality of the evidence was moderate (pneumonia) to low (hypokalaemia). AUTHORS' CONCLUSIONS Evidence of moderate quality suggests that conventional cooling methods provided to induce mild therapeutic hypothermia improve neurological outcome after cardiac arrest, specifically with better outcomes than occur with no temperature management. We obtained available evidence from studies in which the target temperature was 34°C or lower. This is consistent with current best medical practice as recommended by international resuscitation guidelines for hypothermia/targeted temperature management among survivors of cardiac arrest. We found insufficient evidence to show the effects of therapeutic hypothermia on participants with in-hospital cardiac arrest, asystole or non-cardiac causes of arrest.
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Affiliation(s)
- Jasmin Arrich
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
| | - Michael Holzer
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
| | - Christof Havel
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
| | - Marcus Müllner
- Internistisches Zentrum BrigittenauTreustrasse 43ViennaAustria1200
| | - Harald Herkner
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
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Ultrarapid Induction of Hypothermia Using Continuous Automated Peritoneal Lavage With Ice-Cold Fluids: Final Results of the Cooling for Cardiac Arrest or Acute ST-Elevation Myocardial Infarction Trial. Crit Care Med 2015. [PMID: 26196354 DOI: 10.1097/ccm.0000000000001158] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hypothermia (32-34 °C) can mitigate ischemic brain injury, and some evidence suggests that it can reduce infarct size in acute myocardial infarction and acute ischemic stroke. For some indications, speed of cooling may be crucial in determining efficacy. We performed a multicenter prospective intervention study to test an ultrarapid cooling technology, the Velomedix Automated Peritoneal Lavage System using ice-cold fluids continuously circulating through the peritoneal cavity to rapidly induce and maintain hypothermia in comatose patients after cardiac arrest and a small number of awake patients with acute myocardial infarction. DESIGN Multicenter prospective intervention study. SETTING Intensive care- and coronary care units of multiple tertiary referral centers. MEASUREMENTS AND MAIN RESULTS Access to the peritoneal cavity was gained using a modified blunt dilating instrument, followed by catheter placement. Patients were cooled to a temperature of 32.5 °C, maintained for 24 hours (cardiac arrest) or 3 hours (acute myocardial infarction) followed by controlled rewarming. Forty-nine patients were enrolled, and 46 patients completed treatment. One placement was unsuccessful (abdominal wall not breached), two patients were ultimately not cooled, and only safety data are reported. Average catheter insertion time was 2.3 minutes. Mean time to temperature less than 33 °C was 10.4 minutes (average cooling rate, 14 °C/hr). Median infarct size in patients who had coronary interventions was 16% of LV. No cases of stent thrombosis occurred. Survival in cardiac arrest patients with initial rhythm of ventricular tachycardia/ventricular fibrillation was 56%, of whom 82 had a complete neurologic recovery. This compares favorably to outcomes from previous studies. CONCLUSION Automated peritoneal lavage system is a safe and ultrarapid method to induce and maintain hypothermia, which appears feasible in cardiac arrest patients and awake patients with acute myocardial infarction. The shivering response appeared to be delayed and much reduced with this technology, diminishing metabolic disorders associated with cooling and minimizing sedation requirement. Our data suggest that ultrarapid cooling could prevent subtle neurologic damage compared with slower cooling. This will need to be confirmed in direct comparative studies.
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Howes D, Gray SH, Brooks SC, Boyd JG, Djogovic D, Golan E, Green RS, Jacka MJ, Sinuff T, Chaplin T, Smith OM, Owen J, Szulewski A, Murphy L, Irvine S, Jichici D, Muscedere J. Canadian Guidelines for the use of targeted temperature management (therapeutic hypothermia) after cardiac arrest: A joint statement from The Canadian Critical Care Society (CCCS), Canadian Neurocritical Care Society (CNCCS), and the Canadian Critical Care Trials Group (CCCTG). Resuscitation 2015; 98:48-63. [PMID: 26417702 DOI: 10.1016/j.resuscitation.2015.07.052] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/25/2015] [Accepted: 07/30/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel Howes
- Department of Emergency Medicine Queen's University, Kingston, ON, Canada; Queen's University, Kingston, ON, Canada.
| | - Sara H Gray
- Division of Emergency Medicine, Department of Medicine, and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Steven C Brooks
- Department of Emergency Medicine Queen's University, Kingston, ON, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michael's, Toronto, ON, Canada
| | - J Gordon Boyd
- Queen's University, Kingston, ON, Canada; Division of Neurology Department of Medicine Queen's University, Kingston, ON, Canada
| | - Dennis Djogovic
- Division of Critical Care Medicine and Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eyal Golan
- Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Robert S Green
- Department of Emergency Medicine, Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada
| | - Michael J Jacka
- Departments of Anesthesiology and Critical Care, University of Alberta Hospital, Edmonton, AB, Canada
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Timothy Chaplin
- Department of Emergency Medicine Queen's University, Kingston, ON, Canada
| | - Orla M Smith
- Critical Care Department, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada
| | - Julian Owen
- McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Adam Szulewski
- Department of Emergency Medicine Queen's University, Kingston, ON, Canada
| | - Laurel Murphy
- Department of Emergency Medicine, Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Draga Jichici
- Department of Neurology and Critical Care Medicine, McMaster University, Hamilton, ON, Canada
| | - John Muscedere
- Queen's University, Kingston, ON, Canada; Department of Medicine Queen's University, Kingston, ON, Canada
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Ji Z, Liu K, Cai L, Peng C, Xin R, Gao Z, Zhao E, Rastogi R, Han W, Rafols JA, Geng X, Ding Y. Therapeutic effect of tPA in ischemic stroke is enhanced by its combination with normobaric oxygen and hypothermia or ethanol. Brain Res 2015; 1627:31-40. [PMID: 26319679 DOI: 10.1016/j.brainres.2015.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Our lab has previously elucidated the neuroprotective effects of normobaric oxygen (NBO) and ethanol (EtOH) in ischemic stroke. The present study further evaluated the effect of EtOH or hypothermia (Hypo) in the presence of low concentration of NBO and determined whether EtOH can substitute hypothermia in a more clinically relevant autologous embolus rat stroke model in which reperfusion was established by tissue-type plasminogen activator (t-PA). METHODS At 1h of middle cerebral artery occlusion (MCAO) by an autologous embolus, rats received t-PA. In addition, at the same time, ischemic animals were treated with either EtOH (1.0 g/kg) or hypothermia (33°C for 3h) in combination with NBO (60% for 3h). Extent of neuroprotection was assessed by apoptotic cell death measured by ELISA and Western immunoblotting analysis for pro- (AIF, activated Caspase-3, Bax) and anti-apoptotic (Bcl-2) protein expression at 3 and 24h of reperfusion induced by t-PA administration. RESULTS Compared to ischemic rats treated only with t-PA, animals with NBO, hypothermia or EtOH had significantly reduced apoptotic cell death by 32.5%, 43.1% and 36.0% respectively. Furthermore, combination therapy that included NBO+EtOH or NBO+Hypo with t-PA exhibited a much larger decline (p<0.01) in the cell death by 71.1% and 73.6%, respectively. Similarly, NBO+EtOH or NBO+Hypo treatment in addition to t-PA enhanced beneficial effects on both pro- and anti-apoptotic protein expressions as compared to other options. CONCLUSIONS Neuroprotection after stroke can be enhanced by combination treatment with either EtOH or hypothermia in the presence of t-PA and 60% NBO. Because the effects produced by EtOH and hypothermia are comparable, their mechanism of action may be not only similar but also could be interchangeable in future clinical trials.
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Affiliation(s)
- Zhili Ji
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kayin Liu
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lipeng Cai
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Changya Peng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ruiqiang Xin
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhi Gao
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - Ethan Zhao
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Radhika Rastogi
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Wei Han
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Jose A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.
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Li X, Liu L, Luo F, Gui L, Fan D, Xie Q. Effect of mild hypothermia on the increase of CD11b+ Gr-1+ myeloid-derived suppressor cells induced by lipopolysaccharide in a mouse model of sepsis. Am J Emerg Med 2015; 33:1430-5. [PMID: 26275630 DOI: 10.1016/j.ajem.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/11/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE This study aimed to investigate the influence of mild hypothermia on the number of CD11b+ Gr-1+ myeloid-derived suppressor cells (MDSCs) induced by lipopolysaccharide (LPS) injection in mice with sepsis. METHODS BALB/c mice were administered LPS to establish a mouse model of sepsis. Then, these mice were randomly divided into 3 groups: the mild hypothermia plus LPS group, the normothermia plus LPS group, and the LPS group. The normal control group was injected the same amount of 0.9% sodium chloride solution. The ratio of CD11b+ Gr-1+ MDSCs in the mouse spleen and bone marrow was determined at 6, 12, 24, 48, and 72 hours after LPS injection and after injected 0.9% sodium chloride solution. RESULTS Compared with the control group, the number of MDSCs in the spleen in the sepsis group increased gradually, and the difference was significant at 12 hours after injection (P<.01). Moreover, the number of MDSCs was the lowest in the mild hypothermia group, and there was a significant difference than the other 2 groups at 48 hours (P<.01). The number of MDSCs in the bone marrow increased gradually, and the difference between the sepsis and control groups was significant at 24 hours (P<.01). The number of MDSCs in the mild hypothermia group was the lowest, and there was a statistically significant difference than the other 2 groups (P<.05). CONCLUSION Mild hypothermia inhibited the production and accumulation of MDSCs induced by LPS administration in septic mice.
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Affiliation(s)
- Xiaoshuang Li
- Department of Emergency, Clinical College of Pediatrics, Anhui Medical University, Anhui Provincial Children's Hospital, Hefei, China
| | - Li Liu
- Department of Emergency, Clinical College of Pediatrics, Anhui Medical University, Anhui Provincial Children's Hospital, Hefei, China
| | - Feifei Luo
- Department of Emergency, Clinical College of Pediatrics, Anhui Medical University, Anhui Provincial Children's Hospital, Hefei, China
| | - Li Gui
- Comprehensive Laboratory, Basic Medical School of Anhui Medical University, Hefei, China
| | - Dazhi Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Qilian Xie
- Department of Emergency, Clinical College of Pediatrics, Anhui Medical University, Anhui Provincial Children's Hospital, Hefei, China.
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Affiliation(s)
- Kees H Polderman
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (K.H.P.); University of Pittsburgh Medical Center, Pittsburgh, PA (K.H.P.); University of Texas Health Science Center at Houston (J.V.); University of Texas Medical Branch at Galveston (J.V.); and University General Hospital, Houston, TX (J.V.).
| | - Joseph Varon
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (K.H.P.); University of Pittsburgh Medical Center, Pittsburgh, PA (K.H.P.); University of Texas Health Science Center at Houston (J.V.); University of Texas Medical Branch at Galveston (J.V.); and University General Hospital, Houston, TX (J.V.)
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Induced Hypothermia Does Not Harm Hemodynamics after Polytrauma: A Porcine Model. Mediators Inflamm 2015; 2015:829195. [PMID: 26170533 PMCID: PMC4481088 DOI: 10.1155/2015/829195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The deterioration of hemodynamics instantly endangers the patients' life after polytrauma. As accidental hypothermia frequently occurs in polytrauma, therapeutic hypothermia still displays an ambivalent role as the impact on the cardiopulmonary function is not yet fully understood. METHODS We have previously established a porcine polytrauma model including blunt chest trauma, penetrating abdominal trauma, and hemorrhagic shock. Therapeutic hypothermia (34°C) was induced for 3 hours. We documented cardiovascular parameters and basic respiratory parameters. Pigs were euthanized after 15.5 hours. RESULTS Our polytrauma porcine model displayed sufficient trauma impact. Resuscitation showed adequate restoration of hemodynamics. Induced hypothermia had neither harmful nor major positive effects on the animals' hemodynamics. Though heart rate significantly decreased and mixed venous oxygen saturation significantly increased during therapeutic hypothermia. Mean arterial blood pressure, central venous pressure, pulmonary arterial pressure, and wedge pressure showed no significant differences comparing normothermic trauma and hypothermic trauma pigs during hypothermia. CONCLUSIONS Induced hypothermia after polytrauma is feasible. No major harmful effects on hemodynamics were observed. Therapeutic hypothermia revealed hints for tissue protective impact. But the chosen length for therapeutic hypothermia was too short. Nevertheless, therapeutic hypothermia might be a useful tool for intensive care after polytrauma. Future studies should extend therapeutic hypothermia.
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Albrecht M, Meybohm P, Broch O, Zitta K, Hein M, Gräsner JT, Renner J, Bein B, Gruenewald M. Evaluation of remote ischaemic post-conditioning in a pig model of cardiac arrest: A pilot study. Resuscitation 2015; 93:89-95. [PMID: 26051813 DOI: 10.1016/j.resuscitation.2015.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/13/2015] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Remote ischaemic post-conditioning (RIPoC) in which transient episodes of ischaemia (e.g. by inflation and deflation of a blood pressure cuff) are applied after a prolonged ischaemia/reperfusion injury, may have the potential to improve patient outcome and survival following cardiac arrest. In this study we employed a pig model of cardiac arrest and successful cardiopulmonary resuscitation to evaluate the effects of RIPoC on haemodynamics, cardiac tissue damage and neurologic deficit. MATERIALS AND METHODS A total of 22 pigs were subjected to ventricular fibrillation, cardiopulmonary resuscitation and randomly assigned to Control or RIPoC treatment consisting of 4 cycles of 5 min femoral artery occlusion followed by 5 min of reperfusion starting 10min after return of spontaneous circulation (ROSC). Post-resuscitation was evaluated by haemodynamics using left ventricular conductance catheters, quantification of cardiac troponin T (cTnT), lactate dehydrogenase (LDH) and creatine kinase (CK). Neurological testing was performed 24h after return of spontaneous circulation (ROSC). RESULTS RIPoC resulted in a statistically significant reduction of serum cTnT levels 4h after ROSC (P ≤ 0.01). LDH and CK concentrations were significantly lower in RIPoC treated pigs 24h after ROSC (P ≤ 0.001), suggesting tissue and/or cardioprotective effects of RIPoC. End-systolic pressure volume relationship was significantly increased in RIPoC treated animals 4h after ROSC (P ≤ 0.05). Neurological testing revealed a trend towards an improved outcome in RIPoC treated animals. CONCLUSIONS We propose that RIPoC applied immediately after ROSC reduces serum concentrations of markers for cell damage and improves end-systolic pressure volume relationship 4h after ROSC.
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Affiliation(s)
- Martin Albrecht
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ole Broch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Karina Zitta
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Marc Hein
- Department of Anaesthesiology, University Hospital RTWH Aachen, Germany
| | - Jan-Thorsten Gräsner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jochen Renner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Berthold Bein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Matthias Gruenewald
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
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Maznyczka AM, Gershlick AH. Therapeutic hypothermia in patients with out-of-hospital arrest. Heart 2015; 101:1265-71. [DOI: 10.1136/heartjnl-2014-307411] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/14/2015] [Indexed: 12/28/2022] Open
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Feketa VV, Marrelli SP. Induction of therapeutic hypothermia by pharmacological modulation of temperature-sensitive TRP channels: theoretical framework and practical considerations. Temperature (Austin) 2015; 2:244-57. [PMID: 27227027 PMCID: PMC4844121 DOI: 10.1080/23328940.2015.1024383] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 12/22/2022] Open
Abstract
Therapeutic hypothermia has emerged as a remarkably effective method of neuroprotection from ischemia and is being increasingly used in clinics. Accordingly, it is also a subject of considerable attention from a basic scientific research perspective. One of the fundamental problems, with which current studies are concerned, is the optimal method of inducing hypothermia. This review seeks to provide a broad theoretical framework for approaching this problem, and to discuss how a novel promising strategy of pharmacological modulation of the thermosensitive ion channels fits into this framework. Various physical, anatomical, physiological and molecular aspects of thermoregulation, which provide the foundation for this text, have been comprehensively reviewed and will not be discussed exhaustively here. Instead, the first part of the current review, which may be helpful for a broader readership outside of thermoregulation research, will build on this existing knowledge to outline possible opportunities and research directions aimed at controlling body temperature. The second part, aimed at a more specialist audience, will highlight the conceptual advantages and practical limitations of novel molecular agents targeting thermosensitive Transient Receptor Potential (TRP) channels in achieving this goal. Two particularly promising members of this channel family, namely TRP melastatin 8 (TRPM8) and TRP vanilloid 1 (TRPV1), will be discussed in greater detail.
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Key Words
- DMH, dorso-medial hypothalamus
- MPA, medial preoptic area of hypothalamus
- TRP, Transient Receptor Potential
- TRPA1, Transient Receptor Potential cation channel, subfamily A, member 1
- TRPM8, Transient Receptor Potential cation channel, subfamily M, member 8
- TRPV1, Transient Receptor Potential cation channel, subfamily V, member 1
- TRPV2, Transient Receptor Potential cation channel, subfamily V, member 2
- TRPV3, Transient Receptor Potential cation channel, subfamily V, member 3
- TRPV4, Transient Receptor Potential cation channel, subfamily V, member 4
- ThermoTRPs
- ThermoTRPs, Thermosensitive Transient Receptor Potential cation channels
- body temperature
- core temperature
- pharmacological hypothermia
- physical cooling
- rMR, rostral medullary raphe region
- therapeutic hypothermia
- thermopharmacology
- thermoregulation
- thermosensitive ion channels
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Affiliation(s)
- Viktor V Feketa
- Department of Molecular Physiology and Biophysics Graduate Program; Cardiovascular Sciences Track; Baylor College of Medicine , Houston, TX, USA
| | - Sean P Marrelli
- Department of Molecular Physiology and Biophysics Graduate Program; Cardiovascular Sciences Track; Baylor College of Medicine, Houston, TX, USA; Department of Anesthesiology; Baylor College of Medicine, Houston, TX, USA
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Schiefecker AJ, Beer R, Broessner G, Kofler M, Schmutzhard E, Helbok R. Can Therapeutic Hypothermia Be Guided by Advanced Neuromonitoring in Neurocritical Care Patients? A Review. Ther Hypothermia Temp Manag 2015; 5:126-34. [PMID: 25875898 DOI: 10.1089/ther.2014.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The impact of therapeutic hypothermia (TH) on long-term neurological outcome is still controversial. Data on the effects of TH on brain homeostasis are mostly derived from experimental research. Invasive multimodal neuromonitoring techniques may provide additional insight into pathophysiological changes associated with primary or secondary brain injury in humans. In this study we describe the principles of multimodal neuromonitoring and its potential in the clinical setting of TH. We call for more research using multimodal neuromonitoring techniques in patients undergoing TH to optimize cooling and rewarming strategies.
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Affiliation(s)
- Alois Josef Schiefecker
- Division of Neurocritical Care, Department of Neurology, Medical University of Innsbruck , Innsbruck, Austria
| | - Ronny Beer
- Division of Neurocritical Care, Department of Neurology, Medical University of Innsbruck , Innsbruck, Austria
| | - Gregor Broessner
- Division of Neurocritical Care, Department of Neurology, Medical University of Innsbruck , Innsbruck, Austria
| | - Mario Kofler
- Division of Neurocritical Care, Department of Neurology, Medical University of Innsbruck , Innsbruck, Austria
| | - Erich Schmutzhard
- Division of Neurocritical Care, Department of Neurology, Medical University of Innsbruck , Innsbruck, Austria
| | - Raimund Helbok
- Division of Neurocritical Care, Department of Neurology, Medical University of Innsbruck , Innsbruck, Austria
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Cardiac arrest with initial arrest rhythm of pulseless electrical activity: do rhythm characteristics correlate with outcome? Am J Emerg Med 2015; 33:891-4. [PMID: 25943040 DOI: 10.1016/j.ajem.2015.03.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/21/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cardiac arrest is a leading cause of death in the United States, with pulseless electrical activity (PEA) as a common initial arrest rhythm. We sought to determine if rate of electrical activity and QRS width correlate with survival in patients who present with PEA out-of-hospital cardiac arrest. METHODS AND RESULTS This is a retrospective review of patients with PEA out-of-hospital cardiac arrest with first documented cardiac rhythm of PEA from January 2010 to September 2013. Demographic, arrest and initial rhythm characteristics, and patient outcome were abstracted via systematic chart review. The initial 20 seconds of each rhythm strip were used to ascertain electrical rate and QRS width. Primary outcome was survival to hospital discharge. Four hundred fourteen patients were eligible for the study. One hundred fifty-two patients did not have sufficient data for analysis. Two hundred sixty-two patients were included in the final analysis with mean age, 66 years. There were 23 (8.8%) survivors and 17 (6.5%) neurologically intact survivors. Mean heart rate was 58 (confidence interval, 54-63) beats per minute, and mean QRS interval was 100 (confidence interval, 95-106) milliseconds. Twenty-nine point seven percent of patients had wide QRS complexes, and 70.3% were narrow. There was no difference in survival in patients based on heart rate (13.1% vs 7.4%, P = .16) or QRS interval (8.7% vs 7.7%, P = .79). CONCLUSIONS In this single emergency medical services agency study, neither PEA electrical rate nor QRS width correlated with survival or neurologic outcome.
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Herff H, Schneider A, Schröder D, Wetsch W, Böttiger BW. [Therapeutic hypothermia in 2015 : Influence of the TTM study on the intensive care procedure after cardiac arrest]. Med Klin Intensivmed Notfmed 2015; 111:47-51. [PMID: 25801376 DOI: 10.1007/s00063-015-0009-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the 1960s, Peter Safar et al. postulated the benefit of postcardiac arrest hypothermia after successful cardiopulmonary resuscitation (CPR). However, therapeutic hypothermia postCPR did not become a standard procedure until the first few years of the new millennium. Various noninvasive and invasive cooling methods are available. Generally, more invasive cooling methods are more effective-but also tend to involve more complications. Furthermore, invasive measures need more time and thus may be instituted late in the postCPR process, delaying the cooling efforts in the initial phase. There is ongoing controversy about when best to commence cooling. CURRENT SITUATION Recent studies of initial out-of-hospital cooling did not show any benefit for the patients compared to starting cooling in the hospital. The exact target temperature is the subject of multiple ongoing discussions. A recent study showed no disadvantage of cooling to 36 ℃ compared to 33 ℃, which is in the widely accepted standard target temperature range of 32-34 ℃. Nevertheless, cooling to 32-34 ℃ according to the 2010 guidelines is still the accepted standard procedure unless and until new studies generate more evidence. The European Resuscitation Council has given advance notice of a statement on the optimal target temperature in the near future. Finally, large registry studies have demonstrated the benefit of combining postCPR hypothermia with early percutaneous cardiac interventions (PCI) in acute coronary syndromes, which are often a cause of cardiac arrest. OUTLOOK Transport of patients after CPR to specialized postcardiac arrest centres with the possibility of acute PCI and cooling, comparable to the transfer of multiple trauma patients to trauma centres, may be beneficial.
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Affiliation(s)
- H Herff
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - A Schneider
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D Schröder
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - W Wetsch
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - B W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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