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Mild hypothermia during cardiopulmonary bypass assisted CABG is associated with improved short- and long-term survival, a 18-year cohort study. PLoS One 2022; 17:e0273370. [PMID: 36007072 PMCID: PMC9409584 DOI: 10.1371/journal.pone.0273370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 11/19/2022] Open
Abstract
Data substantiating the optimal patient body temperature during cooling procedures in cardiac operations are currently unavailable. To explore the optimal temperature strategy, we examined the association between temperature management and survival among patients during cardiopulmonary bypass assisted coronary artery bypass grafting (CABG) procedures on 30-days and 5-year postoperative survival. Adult patients (n = 5,672, 23.6% female and mean (SD) age of 66 (10) years) operated between 1997 and 2015 were included, with continuous measured intraoperative nasopharyngeal temperatures. The association between mortality and patient characteristics, laboratory parameters, the lowest intraoperative plateau temperature and intraoperative cooling/rewarming rates were examined by multivariate Cox regression analysis. Machine learning-based cluster analysis was used to identify patient subgroups based on pre-cooling parameters and explore whether specific subgroups benefitted from a particular temperature management. Mild hypothermia (32–35°C) was independently associated with improved 30-days and 5-year survival compared to patients in other temperature categories regardless of operation year. 30 days and 5-year survival were 98% and 88% in the mild hypothermia group, whereas it amounted 93% and 80% in the severe hypothermia (<30°C). Normothermia (35–37°C) showed the lowest survival after 30 days and 5 years amounting 93% and 72%, respectively. Cluster analysis identified 8 distinct patient subgroups principally defined by gender, age, kidney function and weight. The full cohort and all patient subgroups displayed the highest survival at a temperature of 32°C. Given these associations, further prospective randomized controlled trials are needed to ascertain optimal patient temperatures during CPB.
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Early Initiation of Continuous Renal Replacement Therapy Induces Fast Hypothermia and Improves Post-Cardiac Arrest Syndrome in a Porcine Model. Shock 2020; 52:456-467. [PMID: 30335673 DOI: 10.1097/shk.0000000000001276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rapid induction of hypothermia early after resuscitation can be an effective strategy against post-cardiac arrest syndrome (PCAS). Preliminary data suggested that continuous renal replacement therapy (CRRT) might be an efficient method to rapidly induce hypothermia. In this study, we investigated the efficacy of cooling induced by CRRT and its effects on the outcomes of PCAS in a porcine model.Thirty-two male domestic pigs weighing 36 ± 2 kg were randomized into 4 groups: sham control (n = 5), normothermia (n = 9), surface cooling (SC, n = 9), and CRRT (n = 9). Sham animals underwent the surgical preparation only. The animal model was established by 8 min of untreated ventricular fibrillation and then 5 min of cardiopulmonary resuscitation. At 5 min after resuscitation, the animals were cooled by either the combination of an earlier 8-h CRRT and later 16-h SC or the whole 24-h SC in the 2 hypothermic groups. For the other 2 groups, a normal temperature of 38.0 ± 0.5°C was maintained throughout the experiment.Blood temperature was decreased to 33°C within 28 min in animals treated with CRRT, which was significantly faster than that in the SC group requiring 185 min to achieve target temperature. Post-resuscitation myocardial dysfunction, brain injury, and systemic inflammation were significantly improved in the 2 hypothermic groups compared to the normothermia group. However, the improvement was significantly greater in the CRRT group than in the SC group.In conclusion, fast hypothermia was successfully induced by CRRT and significantly alleviated the severity of PCAS in a porcine model.
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Maekawa T, Kaneda K, Tsuruta R, Kuroda Y, Nagao K, Rinka H, Takahashi T, Yokota H, Shirai SI, Hase M, Kotani J, Endo S. Precision and Safety of an Intravascular Temperature Management System for Postcardiac Arrest Syndrome Patients: A Multicenter Clinical Trial (COOL-ARREST JP). Ther Hypothermia Temp Manag 2020; 10:179-185. [PMID: 32348714 PMCID: PMC7482718 DOI: 10.1089/ther.2019.0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rapid induction and maintaining a target temperature of 32.0–36.0°C within a narrow range for <24 hours are essential, but those are very hard to perform in postcardiac arrest syndrome (PCAS) patients. We investigated the usability of an intravascular temperature management (IVTM) system with neurolept-anesthesia (NLA; droperidol and fentanyl). Single-arm, prospective multicenter trial was carried out in the seven university and the three affiliated hospitals. In the 24 comatose PCAS patients, the target temperature (33.0°C) was rapidly induced and maintained for 24 hours using an IVTM system with NLA. The rewarming speed was 0.1°C/h until 36.5°C and was maintained for 24 hours. The primary end point was the ability to achieve ≤34.0°C for <3 hours after starting cooling, and the secondary end points were the cooling rate, deviation from the target temperature, and adverse events. Cerebral Performance Category (CPC) score at 14 days was also evaluated. Statistical analyses were performed by SPSS software, using the intention-to-treat data sets. The target temperature of ≤34.0°C was reached by 45 minutes (35–73 minutes) and was within 3 hours in all patients. The cooling rate from 36.4°C to 33.0°C was 2.7°C/h (2.4–3.6°C/h). The temperature of 33.1°C (33.1–33.1°C) and 36.7°C (36.6–36.9°C) for 24 hours each was held during the maintenance and the after rewarming phases, respectively. Temperature deviations >0.2°C from 33.0°C in the maintenance phase occurred once each in two patients. The favorable neurological outcomes (CPC1, 2) were relatively good (50%). Five patients experienced serious adverse events; none was device related. We rapidly achieved therapeutic hypothermia within a narrow temperature range without major complications using the IVTM system with NLA in PCAS patients.
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Affiliation(s)
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Miki, Japan
| | - Ken Nagao
- Cardiovascular Disease Center, Nihon University Hospital (Surugadai), Nihon University Hospital, Tokyo, Japan
| | - Hiroshi Rinka
- Emergency and Critical Medical Care Center, Osaka City General Hospital, Osaka, Japan
| | | | - Hiroyuki Yokota
- Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Shin-Ichi Shirai
- Cardio-Vascular Center, Kokura Memorial Hospital, Fukuoka, Japan
| | - Mamoru Hase
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | - Joji Kotani
- Center for Emergency and Critical Care Medicine, Kobe University Hospital, Kobe University Hospital, Kobe, Japan
| | - Shigeatsu Endo
- Advanced Emergency and Critical Care Center, Iwate Medical University Hospital, Morioka, Japan
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Xu J, Jin X, Chen Q, Wu C, Li Z, Zhou G, Xu Y, Qian A, Li Y, Zhang M. Faster Hypothermia Induced by Esophageal Cooling Improves Early Markers of Cardiac and Neurological Injury After Cardiac Arrest in Swine. J Am Heart Assoc 2019; 7:e010283. [PMID: 30608213 PMCID: PMC6404192 DOI: 10.1161/jaha.118.010283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background After cardiopulmonary resuscitation, the protective effects of therapeutic hypothermia induced by conventional cooling are limited. Recently, esophageal cooling (EC) has been shown to be an effective, easily performed approach to induce therapeutic hypothermia. In this study we investigated the efficacy of EC and its effects on early markers of postresuscitation cardiac and neurological injury in a porcine model of cardiac arrest. Methods and Results Thirty‐two male domestic swine were randomized into 4 groups: sham control, normothermia, surface cooling, and EC. Sham animals underwent the surgical preparation only. Ventricular fibrillation was induced and untreated for 8 minutes while defibrillation was attempted after 5 minutes of cardiopulmonary resuscitation. At 5 minutes after resuscitation, therapeutic hypothermia was induced by either EC or surface cooling to reach a target temperature of 33°C until 24 hours postresuscitation, followed by a rewarming rate of 1°C/h for 5 hours. The temperature was normally maintained in the control and normothermia groups. After resuscitation, a significantly faster decrease in blood temperature was observed in the EC group than in the surface cooling group (2.8±0.7°C/h versus 1.5±0.4°C/h; P<0.05). During the maintenance and rewarming phases the temperature was maintained at an even level between the 2 groups. Postresuscitation cardiac and neurological damage was significantly improved in the 2 hypothermic groups compared with the normothermia group; however, the protective effects were significantly greater in the EC group. Conclusions In a porcine model of cardiac arrest, faster hypothermia successfully induced by EC was significantly better than conventional cooling in improving early markers of postresuscitation cardiac and neurological injury.
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Affiliation(s)
- Jiefeng Xu
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China.,3 Department of Emergency Medicine Yuyao People's Hospital Medical School of Ningbo University Ningbo China
| | - Xiaohong Jin
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China.,4 Department of Emergency Medicine The First People's Hospital of Wenling Taizhou China
| | - Qijiang Chen
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China.,5 Department of Intensive Care Medicine The First Hospital of Ninghai Ningbo China
| | - Chunshuang Wu
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Zilong Li
- 3 Department of Emergency Medicine Yuyao People's Hospital Medical School of Ningbo University Ningbo China
| | - Guangju Zhou
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Yongan Xu
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Anyu Qian
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Yulin Li
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
| | - Mao Zhang
- 1 Department of Emergency Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China.,2 Institute of Emergency Medicine Zhejiang University Hangzhou China
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Noc M, Friberg H, Huang CH, Empey PE. Therapeutic Hypothermia in Cardiac Arrest. Ther Hypothermia Temp Manag 2018; 8:195-198. [PMID: 30412452 DOI: 10.1089/ther.2018.29051.mjn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Marko Noc
- 1 Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Hans Friberg
- 2 Department of Emergency Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Chien-Hua Huang
- 3 Department of Emergency Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Philip E Empey
- 4 Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Lundbye J, Lyden PD, Polderman KH, Schwab S. Clinical Studies Targeting Stroke and Ischemic Insults. Ther Hypothermia Temp Manag 2018; 7:12-15. [PMID: 28253089 DOI: 10.1089/ther.2016.29022.jjl] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Justin Lundbye
- 1 Hospital of Central Connecticut , New Britain, Connecticut
| | - Patrick D Lyden
- 2 Department of Neurology, Cedars-Medical Center , Los Angeles, California
| | - Kees H Polderman
- 3 Department of Critical Care, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Stefan Schwab
- 4 Department of Neurology, Friedrich-Alexander University , Erlangen, Germany
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Nguyen PL, Alreshaid L, Poblete RA, Konye G, Marehbian J, Sung G. Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest. Front Neurol 2018; 9:768. [PMID: 30254606 PMCID: PMC6141756 DOI: 10.3389/fneur.2018.00768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/24/2018] [Indexed: 01/14/2023] Open
Abstract
Out-of-hospital cardiac arrest (CA) remains a leading cause of sudden morbidity and mortality; however, outcomes have continued to improve in the era of targeted temperature management (TTM). In this review, we highlight the clinical use of TTM, and provide an updated summary of multimodality monitoring possible in a modern ICU. TTM is neuroprotective for survivors of CA by inhibiting multiple pathophysiologic processes caused by anoxic brain injury, with a final common pathway of neuronal death. Current guidelines recommend the use of TTM for out-of-hospital CA survivors who present with a shockable rhythm. Further studies are being completed to determine the optimal timing, depth and duration of hypothermia to optimize patient outcomes. Although a multidisciplinary approach is necessary in the CA population, neurologists and neurointensivists are central in selecting TTM candidates and guiding patient care and prognostic evaluation. Established prognostic tools include clinal exam, SSEP, EEG and MR imaging, while functional MRI and invasive monitoring is not validated to improve outcomes in CA or aid in prognosis. We recommend that an evidence-based TTM and prognostication algorithm be locally implemented, based on each institution's resources and limitations. Given the high incidence of CA and difficulty in predicting outcomes, further study is urgently needed to determine the utility of more recent multimodality devices and studies.
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Affiliation(s)
- Peggy L Nguyen
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Laith Alreshaid
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Roy A Poblete
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Geoffrey Konye
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jonathan Marehbian
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Gene Sung
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Abstract
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management.
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9
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Abstract
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management.
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Affiliation(s)
- Fred Rincon
- Division of Critical Care and Neurotrauma, Department of Neurology, Sidney-Kimmel College of Medicine, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA; Division of Critical Care and Neurotrauma, Department of Neurological Surgery, Sidney-Kimmel College of Medicine, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
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10
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Polderman K, Malinoski D, Timerman S, Keeble T. Current Advances in the Use of Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2018; 8:9-13. [PMID: 29356614 DOI: 10.1089/ther.2017.29040.khp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Kees Polderman
- 1 Department of Critical Care, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Darren Malinoski
- 2 Department of Surgery, Oregon Health & Science University , Portland, Oregon
| | - Sergio Timerman
- 3 Medicine and Health Sciences, Laureate International Universities , Sao Paulo, Brazil
| | - Thomas Keeble
- 4 Essex Cardiothoracic Centre, Anglia Ruskin University , Cambridge, United Kingdom
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Dietrich WD, Bramlett HM. Therapeutic hypothermia and targeted temperature management for traumatic brain injury: Experimental and clinical experience. Brain Circ 2017; 3:186-198. [PMID: 30276324 PMCID: PMC6057704 DOI: 10.4103/bc.bc_28_17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) is a worldwide medical problem, and currently, there are few therapeutic interventions that can protect the brain and improve functional outcomes in patients. Over the last several decades, experimental studies have investigated the pathophysiology of TBI and tested various pharmacological treatment interventions targeting specific mechanisms of secondary damage. Although many preclinical treatment studies have been encouraging, there remains a lack of successful translation to the clinic and no therapeutic treatments have shown benefit in phase 3 multicenter trials. Therapeutic hypothermia and targeted temperature management protocols over the last several decades have demonstrated successful reduction of secondary injury mechanisms and, in some selective cases, improved outcomes in specific TBI patient populations. However, the benefits of therapeutic hypothermia have not been demonstrated in multicenter randomized trials to significantly improve neurological outcomes. Although the exact reasons underlying the inability to translate therapeutic hypothermia into a larger clinical population are unknown, this failure may reflect the suboptimal use of this potentially powerful therapeutic in potentially treatable severe trauma patients. It is known that multiple factors including patient recruitment, clinical treatment variables, and cooling methodologies are all important in yielding beneficial effects. High-quality multicenter randomized controlled trials that incorporate these factors are required to maximize the benefits of this experimental therapy. This article therefore summarizes several factors that are important in enhancing the beneficial effects of therapeutic hypothermia in TBI. The current failures of hypothermic TBI clinical trials in terms of clinical protocol design, patient section, and other considerations are discussed and future directions are emphasized.
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Affiliation(s)
- W Dalton Dietrich
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Helen M Bramlett
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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Goury A, Poirson F, Chaput U, Voicu S, Garçon P, Beeken T, Malissin I, Kerdjana L, Chelly J, Vodovar D, Oueslati H, Ekherian JM, Marteau P, Vicaut E, Megarbane B, Deye N. Targeted temperature management using the "Esophageal Cooling Device" after cardiac arrest (the COOL study): A feasibility and safety study. Resuscitation 2017; 121:54-61. [PMID: 28951293 DOI: 10.1016/j.resuscitation.2017.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Targeted temperature management (TTM) between 32 and 36°C is recommended after out-of-hospital cardiac arrest (OHCA). We aimed to assess the feasibility and safety of the "Esophageal Cooling Device" (ECD) in performing TTM. PATIENTS AND METHODS This single-centre, prospective, interventional study included 17 comatose OHCA patients. Main exclusion criteria were: delay between OHCA and return of spontaneous circulation (ROSC)>60min, delay between sustained ROSC and inclusion >360min, known oesophageal disease. A TTM between 32 and 34°C was performed using the ECD (Advanced Cooling Therapy, USA) connected to a heat exchanger console (Meditherm III®, Gaymar, France), without cold fluids' use. Primary endpoint was feasibility of inducing, maintaining TTM, and rewarming using the ECD alone. Secondary endpoints were adverse events, focusing on potential digestive damages. Results were expressed as median (interquartiles 25-75). RESULTS Cooling rate to reach the Target Temperature (33°C-TT) was 0.26°C/h [0.19-0.36]. All patients reached the 32-34°C range with a time spent within the range of 26h [21-28] (3 patients did not reach 33°C). Temperature deviation outside the TT during TTM-maintenance was 0.10°C [0.03-0.20]. Time with deviation >1°C was 0h. Rewarming rate was 0.20°C/h [0.18-0.22]. Among the 16 gastrointestinal endoscopy procedures performed, 10 (62.5%) were normal. Minor oeso-gastric injuries (37.5% and 19%, respectively) were similar to usual orogastric tube injuries. One patient experienced severe oesophagitis mimicking peptic lesions, not cooling-related. No patient among the 9 alive at 3-month follow-up had gastrointestinal complains. CONCLUSION ECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33°C-TTM, particularly during the maintenance phase.
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Affiliation(s)
- Antoine Goury
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Florent Poirson
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Ulriikka Chaput
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Pierre Garçon
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Thomas Beeken
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Isabelle Malissin
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Lamia Kerdjana
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jonathan Chelly
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; Clinical Research Unit-Groupe Hospitalier Sud Île de France, 77000 Melun, France
| | - Dominique Vodovar
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Haikel Oueslati
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jean Michel Ekherian
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Philippe Marteau
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, AP-HP, Paris Cedex 10, France
| | - Bruno Megarbane
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM UMRS-1144, Paris, France
| | - Nicolas Deye
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM U942, Hôpital Lariboisière, Paris, France.
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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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Kohlhauer M, Berdeaux A, Ghaleh B, Tissier R. Therapeutic hypothermia to protect the heart against acute myocardial infarction. Arch Cardiovasc Dis 2016; 109:716-722. [DOI: 10.1016/j.acvd.2016.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 10/20/2022]
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15
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Lee JH, Wei ZZ, Cao W, Won S, Gu X, Winter M, Dix TA, Wei L, Yu SP. Regulation of therapeutic hypothermia on inflammatory cytokines, microglia polarization, migration and functional recovery after ischemic stroke in mice. Neurobiol Dis 2016; 96:248-260. [PMID: 27659107 PMCID: PMC5161414 DOI: 10.1016/j.nbd.2016.09.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/30/2016] [Accepted: 09/17/2016] [Indexed: 01/08/2023] Open
Abstract
Stroke is a leading threat to human life and health in the US and around the globe, while very few effective treatments are available for stroke patients. Preclinical and clinical studies have shown that therapeutic hypothermia (TH) is a potential treatment for stroke. Using novel neurotensin receptor 1 (NTR1) agonists, we have demonstrated pharmacologically induced hypothermia and protective effects against brain damages after ischemic stroke, hemorrhage stroke, and traumatic brain injury (TBI) in rodent models. To further characterize the mechanism of TH-induced brain protection, we examined the effect of TH (at ±33°C for 6h) induced by the NTR1 agonist HPI-201 or physical (ice/cold air) cooling on inflammatory responses after ischemic stroke in mice and oxygen glucose deprivation (OGD) in cortical neuronal cultures. Seven days after focal cortical ischemia, microglia activation in the penumbra reached a peak level, which was significantly attenuated by TH treatments commenced 30min after stroke. The TH treatment decreased the expression of M1 type reactive factors including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-12, IL-23, and inducible nitric oxide synthase (iNOS) measured by RT-PCR and Western blot analyses. Meanwhile, TH treatments increased the expression of M2 type reactive factors including IL-10, Fizz1, Ym1, and arginase-1. In the ischemic brain and in cortical neuronal/BV2 microglia cultures subjected to OGD, TH attenuated the expression of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1α (MIP-1α), two key chemokines in the regulation of microglia activation and infiltration. Consistently, physical cooling during OGD significantly decreased microglia migration 16h after OGD. Finally, TH improved functional recovery at 1, 3, and 7days after stroke. This study reveals the first evidence for hypothermia mediated regulation on inflammatory factor expression, microglia polarization, migration and indicates that the anti-inflammatory effect is an important mechanism underlying the brain protective effects of a TH therapy.
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Affiliation(s)
- Jin Hwan Lee
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States
| | - Zheng Z Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States
| | - Wenyuan Cao
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Soonmi Won
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Xiaohuan Gu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States
| | - Megan Winter
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Thomas A Dix
- JT Pharmaceuticals, Mt. Pleasant, SC 29464, United States; Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29401, United States
| | - Ling Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Shan Ping Yu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States.
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Saunderson CE, Chowdhary A, Brogan RA, Batin PD, Gale CP. In an era of rapid STEMI reperfusion with Primary Percutaneous Coronary Intervention is there a role for adjunct therapeutic hypothermia? A structured literature review. Int J Cardiol 2016; 223:883-890. [DOI: 10.1016/j.ijcard.2016.08.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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