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Neurotrauma and Intracranial Pressure Management. Crit Care Clin 2023; 39:103-121. [DOI: 10.1016/j.ccc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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2
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Hypothermia is associated with a low ETCO2 and low pH-stat PaCO2 in refractory cardiac arrest. Resuscitation 2022; 174:83-90. [DOI: 10.1016/j.resuscitation.2022.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 11/23/2022]
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Protein S100B as a reliable tool for early prognostication after cardiac arrest. Resuscitation 2020; 156:251-259. [DOI: 10.1016/j.resuscitation.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/15/2020] [Accepted: 08/08/2020] [Indexed: 02/05/2023]
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Friberg H, Paidas MJ, Lorenzo J, Deye N. Unique Uses of Cooling Strategies. Ther Hypothermia Temp Manag 2020; 10:131-134. [PMID: 32780645 DOI: 10.1089/ther.2020.29076.hjf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hans Friberg
- Department of Anesthesiology and Intensive Care, Skane University Hospital, Lund University, Malmö, Sweden
| | - Michael J Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Javier Lorenzo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Nicolas Deye
- Medical & Toxicological Intensive Care Unit, Lariboisiere University Hospital, Hopitaux de Paris, France
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Engrand N, Lebard C, Luis D, Dinkelacker V. Return of spontaneous circulation after an out-of-hospital cardiac arrest: An acute brain injury like others? Resuscitation 2020; 153:268-269. [DOI: 10.1016/j.resuscitation.2020.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 10/24/2022]
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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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Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management. Anesthesiology 2020; 131:186-208. [PMID: 31021845 DOI: 10.1097/aln.0000000000002700] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post-cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32° to 36°C for at least 24 h, whereas rewarming should not increase more than 0.5°C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.
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Engrand N, Mazighi M, Dinkelacker V. Hypothermia after decompressive hemicraniectomy in treatment of malignant middle cerebral artery stroke: comment on the randomized clinical trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:164. [PMID: 31072354 PMCID: PMC6509844 DOI: 10.1186/s13054-019-2452-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/18/2019] [Indexed: 11/13/2022]
Affiliation(s)
- N Engrand
- Neuro-Intensive Care Unit, Fondation Ophtalmologique Rothschild, 29 rue Manin, 75019, Paris, France.
| | - M Mazighi
- Interventional Neuroradiology Department, Fondation Ophtalmologique Rothschild, 29 rue Manin, 75019, Paris, France
| | - V Dinkelacker
- Neurological Department, Fondation Ophtalmologique Rothschild, 29 rue Manin, 75019, Paris, France
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Ebner F, Ullén S, Åneman A, Cronberg T, Mattsson N, Friberg H, Hassager C, Kjærgaard J, Kuiper M, Pelosi P, Undén J, Wise MP, Wetterslev J, Nielsen N. Associations between partial pressure of oxygen and neurological outcome in out-of-hospital cardiac arrest patients: an explorative analysis of a randomized trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:30. [PMID: 30691510 PMCID: PMC6348606 DOI: 10.1186/s13054-019-2322-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/11/2019] [Indexed: 12/31/2022]
Abstract
Objective Exposure to hyperoxemia and hypoxemia is common in out-of-hospital cardiac arrest (OHCA) patients following return of spontaneous circulation (ROSC), but its effects on neurological outcome are uncertain, and study results are inconsistent. Methods Exploratory post hoc substudy of the Target Temperature Management (TTM) trial, including 939 patients after OHCA with return of spontaneous circulation (ROSC). The association between serial arterial partial pressures of oxygen (PaO2) during 37 h following ROSC and neurological outcome at 6 months, evaluated by Cerebral Performance Category (CPC), dichotomized to good (CPC 1–2) and poor (CPC 3–5), was investigated. In our analyses, we tested the association of hyperoxemia and hypoxemia, time-weighted mean PaO2, maximum PaO2 difference, and gradually increasing PaO2 levels (13.3–53.3 kPa) with poor neurological outcome. A subsequent analysis investigated the association between PaO2 and a biomarker of brain injury, peak serum Tau levels. Results Eight hundred sixty-nine patients were eligible for analysis. Three hundred patients (35%) were exposed to hyperoxemia or hypoxemia at some time point after ROSC. Our analyses did not reveal a significant association between hyperoxemia, hypoxemia, time-weighted mean PaO2 exposure or maximum PaO2 difference and poor neurological outcome at 6-month follow-up after correction for co-variates (all analyses p = 0.146–0.847). We were not able to define a PaO2 level significantly associated with the onset of poor neurological outcome. Peak serum Tau levels at either 48 or 72 h after ROSC were not associated with PaO2. Conclusion Hyperoxemia or hypoxemia exposure occurred in one third of the patients during the first 37 h of hospitalization and was not significantly associated with poor neurological outcome after 6 months or with the peak s-Tau levels at either 48 or 72 h after ROSC. Electronic supplementary material The online version of this article (10.1186/s13054-019-2322-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Ebner
- Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, S-251 87, Helsingborg, Sweden.
| | - Susann Ullén
- Clinical Studies Sweden, Skane University Hospital, Remissgatan 4, S-221 85, Lund, Sweden
| | - Anders Åneman
- Department of Intensive Care, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, 1871, Australia
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Niklas Mattsson
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, DK 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, DK 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Michael Kuiper
- Intensive Care Unit, Leeuwarden Medical Centrum, Borniastraat 38, NL8934 AD, Leeuwarden, Netherlands
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Department of Anesthesia and Intensive Care, IRCCS San Martino Policlinico Hospital, Genoa, Italy
| | - Johan Undén
- Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Hallands Hospital, S-30233, Halmstad, Sweden
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, CF144XW, UK
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Dpt. 7812, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, S-251 87, Helsingborg, Sweden
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11
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Ebner F, Harmon MBA, Aneman A, Cronberg T, Friberg H, Hassager C, Juffermans N, Kjærgaard J, Kuiper M, Mattsson N, Pelosi P, Ullén S, Undén J, Wise MP, Nielsen N. Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy. Crit Care 2018; 22:196. [PMID: 30119692 PMCID: PMC6098627 DOI: 10.1186/s13054-018-2119-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Dyscarbia is common in out-of-hospital cardiac arrest (OHCA) patients and its association to neurological outcome is undetermined. Methods This is an exploratory post-hoc substudy of the Target Temperature Management (TTM) trial, including resuscitated OHCA patients, investigating the association between serial measurements of arterial partial carbon dioxide pressure (PaCO2) and neurological outcome at 6 months, defined by the Cerebral Performance Category (CPC) scale, dichotomized to good outcome (CPC 1 and 2) and poor outcome (CPC 3–5). The effects of hypercapnia and hypocapnia, and the time-weighted mean PaCO2 and absolute PaCO2 difference were analyzed. Additionally, the association between mild hypercapnia (6.0–7.30 kPa) and neurological outcome, its interaction with target temperature (33 °C and 36 °C), and the association between PaCO2 and peak serum-Tau were evaluated. Results Of the 939 patients in the TTM trial, 869 were eligible for analysis. Ninety-six percent of patients were exposed to hypocapnia or hypercapnia. None of the analyses indicated a statistical significant association between PaCO2 and neurological outcome (P = 0.13–0.96). Mild hypercapnia was not associated with neurological outcome (P = 0.78) and there was no statistically significant interaction with target temperature (Pinteraction = 0.95). There was no association between PaCO2 and peak serum-Tau levels 48 or 72 h after return of spontaneous circulation (ROSC). Conclusions Dyscarbia is common after ROSC. No statistically significant association between PaCO2 in the post-cardiac arrest phase and neurological outcome at 6 months after cardiac arrest was detected. There was no significant interaction between mild hypercapnia and temperature in relation to neurological outcome. Electronic supplementary material The online version of this article (10.1186/s13054-018-2119-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Ebner
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
| | - Matt B A Harmon
- Department of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, 1871, Australia
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Skåne University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Hans Friberg
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicole Juffermans
- Department of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Jesper Kjærgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kuiper
- Intensive Care Unit, Leeuwarden Medical Centrum, Borniastraat 38, NL8934 AD, Leeuwarden, The Netherlands
| | - Niklas Mattsson
- Department of Clinical Sciences, Neurology, Skåne University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, Anesthesia and Intensive Care, San Martino Policlinico Hospital, University of Genoa, Genoa, Italy
| | - Susann Ullén
- Clinical Studies Sweden, Skåne University Hospital, Remissgatan 4, 221 85, Lund, Sweden
| | - Johan Undén
- Department of Anaesthesia and Intensive Care, Hallands Hospital, Halmstad, Sweden
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, CF144XW, UK
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
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Voicu S, Henry P, Malissin I, Dillinger JG, Koumoulidis A, Magkoutis N, Yannopoulos D, Logeart D, Manzo-Silberman S, Péron N, Deye N, Megarbane B, Sideris G. Improving cannulation time for extracorporeal life support in refractory cardiac arrest of presumed cardiac cause – Comparison of two percutaneous cannulation techniques in the catheterization laboratory in a center without on-site cardiovascular surgery. Resuscitation 2018; 122:69-75. [DOI: 10.1016/j.resuscitation.2017.11.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/18/2017] [Accepted: 11/23/2017] [Indexed: 01/30/2023]
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13
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Nakashima R, Hifumi T, Kawakita K, Okazaki T, Egawa S, Inoue A, Seo R, Inagaki N, Kuroda Y. Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest. Circ J 2017; 81:427-439. [PMID: 28239054 DOI: 10.1253/circj.cj-16-1006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.
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Affiliation(s)
- Ryuta Nakashima
- Department of Emergency and Critical Care Medicine, Oita City Medical Association's Almeida Memorial Hospital
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Abstract
Airway management and ventilation are central to the resuscitation of the neurologically ill. These patients often have evolving processes that threaten the airway and adequate ventilation. Furthermore, intubation, ventilation, and sedative choices directly affect brain perfusion. Therefore, airway, ventilation, and sedation was chosen as an emergency neurological life support protocol. Topics include airway management, when and how to intubate with special attention to hemodynamics and preservation of cerebral blood flow, mechanical ventilation settings, and the use of sedative agents based on the patient's neurological status.
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Eastwood GM, Tanaka A, Bellomo R. Cerebral oxygenation in mechanically ventilated early cardiac arrest survivors: The impact of hypercapnia. Resuscitation 2016; 102:11-6. [DOI: 10.1016/j.resuscitation.2016.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 01/21/2016] [Accepted: 02/06/2016] [Indexed: 11/28/2022]
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16
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Voicu S, Baud FJ, Malissin I, Deye N, Bihry N, Vivien B, Brun PY, Sideris G, Henry P, Megarbane B. Can mortality due to circulatory failure in comatose out-of-hospital cardiac arrest patients be predicted on admission? A study in a retrospective derivation cohort validated in a prospective cohort. J Crit Care 2016; 32:56-62. [DOI: 10.1016/j.jcrc.2015.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 12/18/2022]
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17
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Chelly J, Deye N, Guichard JP, Vodovar D, Vong L, Jochmans S, Thieulot-Rolin N, Sy O, Serbource-Goguel J, Vinsonneau C, Megarbane B, Vivien B, Tazarourte K, Monchi M. The optic nerve sheath diameter as a useful tool for early prediction of outcome after cardiac arrest: A prospective pilot study. Resuscitation 2016; 103:7-13. [PMID: 26995663 DOI: 10.1016/j.resuscitation.2016.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/18/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Optic nerve sheath diameter (ONSD) measurement could detect increased intracranial pressure, and might predict outcome in post-cardiac arrest (CA) patients. We assessed the ability of bedside ONSD ultrasonographic measurement performed within day 1 after CA occurrence to predict in-hospital survival in patients treated with therapeutic hypothermia (TH). METHODS In two French ICUs, a prospective study included all consecutive patients with CA without traumatic or neurological etiology, successfully resuscitated and TH-treated. ONSD measurements were performed on day 1, 2, and 3 (ONSD1, 2, 3 respectively) after return of spontaneous circulation. All records were registered according to Utstein style. RESULTS ONSD1, 2, 3 were assessed in 36, 21, and 14 patients respectively. 19/36 patients (53%) were discharged alive from hospital, including 14/36 (39%) with favorable neurological outcome (Cerebral Performance Category [CPC] score 1-2). Survivors and non-survivors were similar regarding age, sex, cardiovascular risk factors, location and etiology of CA, simplified acute physiology score II, occurrence of post-CA shock, and clinical parameters collected during ONSD measurements. Median ONSD1 was significantly larger in non-survivors versus survivors (7.2mm [interquartile: 6.8-7.4] versus 6.5mm [interquartile: 6.0-6.8]; p=0.008). After adjustment on predictive factors, ONSD1 was significantly associated with in-hospital mortality (OR 6.3; 95%CI [1.05-40] per mm of ONSD1 above 5.5mm; p=0.03), and CPC score (OR for 1 point increase in CPC score: 3.2; 95%CI [1.2-9.4] per mm of ONSD1 above 5.5mm; p=0.03). ONSD1 was significantly correlated with brain edema assessed by the cerebrum gray matter attenuation to white matter attenuation ratio, measured by the brain computed tomography scan performed on admission in 20 patients (Spearman rho=-0.5, p=0.04). CONCLUSIONS ONSD seems a promising tool to early assess outcome in post-CA patients treated with TH.
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Affiliation(s)
- Jonathan Chelly
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
| | - Nicolas Deye
- Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France; INSERM U942, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Jean-Pierre Guichard
- Department of Radiology, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Dominique Vodovar
- Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Ly Vong
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Sebastien Jochmans
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | | | - Oumar Sy
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Jean Serbource-Goguel
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Christophe Vinsonneau
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Bruno Megarbane
- Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Benoit Vivien
- SAMU 75, Hôpital Necker - Enfants Malades - Assistance Publique des Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - Karim Tazarourte
- SAMU 77, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Merhan Monchi
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
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Kudenchuk PJ, Sandroni C, Drinhaus HR, Böttiger BW, Cariou A, Sunde K, Dworschak M, Taccone FS, Deye N, Friberg H, Laureys S, Ledoux D, Oddo M, Legriel S, Hantson P, Diehl JL, Laterre PF. Breakthrough in cardiac arrest: reports from the 4th Paris International Conference. Ann Intensive Care 2015; 5:22. [PMID: 26380990 PMCID: PMC4573754 DOI: 10.1186/s13613-015-0064-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/18/2015] [Indexed: 02/08/2023] Open
Abstract
Jean-Luc Diehl The French Intensive Care Society organized on 5th and 6th June 2014 its 4th "Paris International Conference in Intensive Care", whose principle is to bring together the best international experts on a hot topic in critical care medicine. The 2014 theme was "Breakthrough in cardiac arrest", with many high-quality updates on epidemiology, public health data, pre-hospital and in-ICU cares. The present review includes short summaries of the major presentations, classified into six main chapters: Epidemiology of CA Pre-hospital management Post-resuscitation management: targeted temperature management Post-resuscitation management: optimizing organ perfusion and metabolic parameters Neurological assessment of brain damages Public healthcare.
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Affiliation(s)
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
| | - Hendrik R Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, University of Koeln, Cologne, Germany.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University of Koeln, Cologne, Germany.
| | - Alain Cariou
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France.
- Paris Descartes University and Sorbonne Paris Cité-Medical School and INSERM U970 (Team 4), Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France.
| | - Kjetil Sunde
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Surgical Intensive Care Unit Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Martin Dworschak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Vienna General Hospital, Medical University Vienna, Vienna, Austria.
| | - Fabio Silvio Taccone
- Department of Intensive Care, Laboratoire de Recherche Experimentale, Erasme Hospital, Brussels, Belgium.
| | - Nicolas Deye
- Medical Intensive Care Unit, AP-HP, Lariboisière University Hospital, Inserm U942, Paris, France.
| | - Hans Friberg
- Anaesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège and Liège 2 Department of Neurology, University Hospital of Liège, Liège, Belgium.
| | - Didier Ledoux
- Coma Science Group, Cyclotron Research Centre, University of Liège and Department of Intensive Care Medicine, University Hospital of Liège, Liège, Belgium.
| | - Mauro Oddo
- Department of Intensive Care Medicine, Faculty of Biology and Medicine, CHUV-University Hospital, Lausanne, Switzerland.
| | - Stéphane Legriel
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France.
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - Jean-Luc Diehl
- Medical Intensive Care Unit, AP-HP, European Georges Pompidou Hospital, Paris Descartes University and Sorbonne Paris Cité-Medical School, Paris, France.
| | - Pierre-Francois Laterre
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain Brussels, Brussels, Belgium.
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Terman SW, Nicholas KS, Hume B, Silbergleit R. Clinical Practice Variability in Temperature Correction of Arterial Blood Gas Measurements and Outcomes in Hypothermia-Treated Patients After Cardiac Arrest. Ther Hypothermia Temp Manag 2015; 5:135-42. [DOI: 10.1089/ther.2014.0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samuel Waller Terman
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Katherine S. Nicholas
- Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina
| | - Benjamin Hume
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Robert Silbergleit
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Champion S, Voicu S, Deye N. Conséquences cardiovasculaires de l’hypothermie. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1054-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Lascarrou JB, Meziani F, Le Gouge A, Boulain T, Bousser J, Belliard G, Asfar P, Frat JP, Dequin PF, Gouello JP, Delahaye A, Hssain AA, Chakarian JC, Pichon N, Desachy A, Bellec F, Thevenin D, Quenot JP, Sirodot M, Labadie F, Plantefeve G, Vivier D, Girardie P, Giraudeau B, Reignier J. Therapeutic hypothermia after nonshockable cardiac arrest: the HYPERION multicenter, randomized, controlled, assessor-blinded, superiority trial. Scand J Trauma Resusc Emerg Med 2015; 23:26. [PMID: 25882712 PMCID: PMC4353458 DOI: 10.1186/s13049-015-0103-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic hypothermia, or targeted temperature management (TTM), at 33°C in patients successfully resuscitated after nonshockable cardiac arrest. Nevertheless, the latest recommendations issued by the International Liaison Committee on Resuscitation and by the European Resuscitation Council recommend therapeutic hypothermia. New data are available on the adverse effects of therapeutic hypothermia, notably infectious complications. The risk/benefit ratio of therapeutic hypothermia after nonshockable cardiac arrest is unclear. METHODS HYPERION is a multicenter (22 French ICUs) trial with blinded outcome assessment in which 584 patients with successfully resuscitated nonshockable cardiac arrest are allocated at random to either TTM between 32.5 and 33.5°C (therapeutic hypothermia) or TTM between 36.5 and 37.5°C (therapeutic normothermia) for 24 hours. Both groups are managed with therapeutic normothermia for the next 24 hours. TTM is achieved using locally available equipment. The primary outcome is day-90 neurological status assessed by the Cerebral Performance Categories (CPC) Scale with dichotomization of the results (1 + 2 versus 3 + 4 + 5). The primary outcome is assessed by a blinded psychologist during a semi-structured telephone interview of the patient or next of kin. Secondary outcomes are day-90 mortality, hospital mortality, severe adverse events, infections, and neurocognitive performance. The planned sample size of 584 patients will enable us to detect a 9% absolute difference in day-90 neurological status with 80% power, assuming a 14% event rate in the control group and a two-sided Type 1 error rate of 4.9%. Two interim analyses will be performed, after inclusion of 200 and 400 patients, respectively. DISCUSSION The HYPERION trial is a multicenter, randomized, controlled, assessor-blinded, superiority trial that may provide an answer to an issue of everyday relevance, namely, whether TTM is beneficial in comatose patients resuscitated after nonshockable cardiac arrest. Furthermore, it will provide new data on the tolerance and adverse events (especially infectious complications) of TTM at 32.5-33.5°C. TRIAL REGISTRATION ClinicalTrials.gov: NCT01994772 .
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Affiliation(s)
| | - Ferhat Meziani
- Medical Intensive Care Unit, University Hospital Center, University of Strasbourg, Strasbourg, France.
| | - Amélie Le Gouge
- INSERM CIC1415, CHRU de Tours, Tours, France. .,Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
| | - Thierry Boulain
- Medical Intensive Care Unit, Regional Hospital Center, Orleans, France.
| | - Jérôme Bousser
- Medical-Surgical intensive Care Unit, General Hospital Center, Saint Brieuc, France.
| | - Guillaume Belliard
- Medical Intensive Care Unit, South Brittany General Hospital Center, Lorient, France.
| | - Pierre Asfar
- Medical Intensive Care Unit, University Hospital Center, Angers, France.
| | - Jean Pierre Frat
- Medical Intensive Care Unit, University Hospital Center, Poitiers, France.
| | | | - Jean Paul Gouello
- Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Malo, France.
| | - Arnaud Delahaye
- Medical-Surgical Intensive Care Unit, General Hospital Center, Rodez, France.
| | - Ali Ait Hssain
- Medical Intensive Care Unit, University Hospital Center, Clermond-Ferrand, France.
| | | | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, University Hospital Center, Limoges, France.
| | - Arnaud Desachy
- Medical-Surgical Intensive Care Unit, General Hospital Center, Angouleme, France.
| | - Fréderic Bellec
- Medical-Surgical Intensive Care Unit, General Hospital Center, Montauban, France.
| | - Didier Thevenin
- Medical-Surgical Intensive Care Unit, General Hospital Center, Lens, France.
| | | | - Michel Sirodot
- Medical-Surgical Intensive Care Unit, General Hospital Center, Annecy, France.
| | - François Labadie
- Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Nazaire, France.
| | - Gaétan Plantefeve
- Medical-Surgical Intensive Care Unit, General Hospital Center, Argenteuil, France.
| | - Dominique Vivier
- Medical-Surgical Intensive Care Unit, General Hospital Center, Le Mans, France.
| | - Patrick Girardie
- Medical Intensive Care Unit, University Hospital Center, Lille, France.
| | - Bruno Giraudeau
- INSERM CIC1415, CHRU de Tours, Tours, France. .,Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
| | - Jean Reignier
- Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
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Eastwood GM, Suzuki S, Lluch C, Schneider AG, Bellomo R. A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest. J Crit Care 2014; 30:138-44. [PMID: 25449882 DOI: 10.1016/j.jcrc.2014.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/22/2014] [Accepted: 09/27/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Resuscitated cardiac arrest (CA) patients typically receive therapeutic hypothermia, but arterial blood gases (ABGs) are often assessed after adjustment to 37°C (alpha-stat) instead of actual body temperature (pH-stat). We sought to compare alpha-stat and pH-stat assessment of PaO2 and PaCO2 in such patients. MATERIALS AND METHODS Using ABG data obtained during the first 24 hours of intensive care unit admission, we determined the impact of measured alpha vs calculated pH-stat on PaO2 and PaCO2 on patient classification and outcomes for CA patients. RESULTS We assessed 1013 ABGs from 120 CA patients with a median age of patients 66 years (interquartile range, 50-76). Median alpha-stat PaO2 changed from 122 (95-156) to 107 (82-143) mm Hg with pH-stat and median PaCO2 from 39 (34-46) to 35 (30-41) mm Hg (both P < .001). Using the categories of hyperoxemia, normoxemia, and hypoxemia, pH-stat estimation of PaO2 reclassified approximately 20% of patients. Using the categories of hypercapnia, normocapnia, and hypocapnia, pH stat estimation of PaCO2 reclassified approximately 40% of patients. The mortality of patients in different PaO2 and PaCO2 categories was similar for pH-stat and alpha-stat. CONCLUSIONS Using the pH-stat method, fewer resuscitated CA patients admitted to intensive care unit were classified as hyperoxemic or hypercapnic compared with alpha-stat. These findings suggest an impact of ABG assessment methodology on PaO2, PaCO2 , and patient classification but not on associated outcomes.
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Affiliation(s)
- Glenn M Eastwood
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Victoria, Melbourne, Australia.
| | - Satoshi Suzuki
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan.
| | - Cristina Lluch
- Department of Intensive Care, Hospital Universitari Mutua Terrassa, Barcelona, Spain.
| | - Antoine G Schneider
- Department of Intensive Care Medicine and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Victoria, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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