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Beekman R, Khosla A, Buckley R, Honiden S, Gilmore EJ. Temperature Control in the Era of Personalized Medicine: Knowledge Gaps, Research Priorities, and Future Directions. J Intensive Care Med 2024; 39:611-622. [PMID: 37787185 DOI: 10.1177/08850666231203596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Hypoxic-ischemic brain injury (HIBI) is the leading cause of death and disability after cardiac arrest. To date, temperature control is the only intervention shown to improve neurologic outcomes in patients with HIBI. Despite robust preclinical evidence supporting hypothermia as neuroprotective therapy after cardiac arrest, there remains clinical equipoise regarding optimal core temperature, therapeutic window, and duration of therapy. Current guidelines recommend continuous temperature monitoring and active fever prevention for at least 72 h and additionally note insufficient evidence regarding temperature control targeting 32 °C-36 °C. However, population-based thresholds may be inadequate to support the metabolic demands of ischemic, reperfused, and dysregulated tissue. Promoting a more personalized approach with individualized targets has the potential to further improve outcomes. This review will analyze current knowledge and evidence, address research priorities, explore the components of high-quality temperature control, and define critical future steps that are needed to advance patient-centered care for cardiac arrest survivors.
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Affiliation(s)
- Rachel Beekman
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Akhil Khosla
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Ryan Buckley
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shyoko Honiden
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Emily J Gilmore
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Mark J, Lopez J, Wahood W, Dodge J, Belaunzaran M, Losiniecki F, Santos-Roman Y, Danckers M. The role of targeted temperature management in 30-day hospital readmissions in cardiac arrest survivors: A national population-based study. IJC HEART & VASCULATURE 2023; 46:101207. [PMID: 37113651 PMCID: PMC10127122 DOI: 10.1016/j.ijcha.2023.101207] [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] [Received: 02/27/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Background Targeted temperature management (TTM) implementation following resuscitation from cardiac arrest is controversial. Although prior studies have shown that TTM improves neurological outcomes and mortality, less is known about the rates or causes of readmission in cardiac arrest survivors within 30 days. We aimed to determine whether the implementation of TTM improves all-cause 30-day unplanned readmission rates in cardiac arrest survivors. Methods Using the Nationwide Readmissions Database, we identified 353,379 adult cardiac arrest index hospitalizations and discharges using the International Classification of Diseases, 9th and 10th codes. The primary outcome was 30-day all-cause unplanned readmissions following cardiac arrest discharge. Secondary outcomes included 30-day readmission rates and reasons, including impacts on other organ systems. Results Of 353,379 discharges for cardiac arrest with 30-day readmission, 9,898 (2.80%) received TTM during index hospitalization. TTM implementation was associated with lower 30-day all-cause unplanned readmission rates versus non-recipients (6.30% vs. 9.30%, p < 0.001). During index hospitalization, receiving TTM was also associated with higher rates of AKI (41.12% vs. 37.62%, p < 0.001) and AHF (20.13% vs. 17.30%, p < 0.001). We identified an association between lower rates of 30-day readmission for AKI (18.34% vs. 27.48%, p < 0.05) and trend toward lower AHF readmissions (11.32% vs. 17.97%, p = 0.05) among TTM recipients. Conclusions Our study highlights a possible negative association between TTM and unplanned 30-day readmission in cardiac arrest survivors, thereby potentially reducing the impact and burden of increased short-term readmission in these patients. Future randomized studies are warranted to optimize TTM use during post-arrest care.
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Affiliation(s)
- Justin Mark
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
- Corresponding author at: 3301 College Ave, Fort Lauderdale, FL 33314, United States.
| | - Jose Lopez
- Department of Internal Medicine, HCA Florida Aventura Hospital, FL, United States
| | - Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Joshua Dodge
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Miguel Belaunzaran
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Fergie Losiniecki
- Division of Clinical Cardiac Electrophysiology, Medical University of South Carolina, SC, United States
| | | | - Mauricio Danckers
- Division of Critical Care, HCA Florida Aventura Hospital, FL, United States
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Imataka G, Fujita Y, Kikuchi J, Wake K, Ono K, Yoshihara S. Brain Hypothermia Therapy and Targeted Temperature Management for Acute Encephalopathy in Children: Status and Prospects. J Clin Med 2023; 12:jcm12062095. [PMID: 36983098 PMCID: PMC10058746 DOI: 10.3390/jcm12062095] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
In adult intensive care, brain hypothermia therapy (BHT) was reported to be effective in neuroprotection after resuscitation and cardiac arrest. By contrast, in neonatal intensive care, the pathophysiology of brain damage caused by hypoxic–ischemic encephalopathy (HIE) is attributed to circulatory disturbances resulting from ischemia/reperfusion, for which neonatal brain cryotherapy is used. The International Liaison Committee on Resuscitation, 2010, recommends cerebral cryotherapy for HIE associated with severe neonatal pseudoparenchyma death. The usefulness of BHT for neuroprotection in infants and children, especially in pediatric acute encephalopathy, is expected. Theoretically, BHT could be useful in basic medical science and animal experiments. However, there are limitations in clinical planning for treating pediatric acute encephalopathy. No international collaborative study has been conducted, and no clinical evidence exists for neuroprotection using BHT. In this review, we will discuss the pathogenesis of neuronal damage in hypoxic and hypoperfused brains; the history of BHT, its effects, and mechanisms of action; the success of BHT; cooling and monitoring methods of BHT; adverse reactions to BHT; literature on BHT. We will review the latest literature on targeted temperature management, which is used for maintaining and controlling body temperature in adults in intensive care. Finally, we will discuss the development of BHT and targeted temperature management as treatments for pediatric acute encephalopathy.
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Affiliation(s)
- George Imataka
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
- Correspondence: ; Tel.: +81-282-86-1111
| | - Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Jin Kikuchi
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Koji Wake
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Kazuyuki Ono
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
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Zhang Q, Zhang C, Liu C, Zhan H, Li B, Lu Y, Wei H, Cheng J, Li S, Wang C, Hu C, Liao X. Identification and Validation of Novel Potential Pathogenesis and Biomarkers to Predict the Neurological Outcome after Cardiac Arrest. Brain Sci 2022; 12:brainsci12070928. [PMID: 35884735 PMCID: PMC9316619 DOI: 10.3390/brainsci12070928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/22/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Predicting neurological outcomes after cardiac arrest remains a major issue. This study aimed to identify novel biomarkers capable of predicting neurological prognosis after cardiac arrest. Expression profiles of GSE29540 and GSE92696 were downloaded from the Gene Expression Omnibus (GEO) database to obtain differentially expressed genes (DEGs) between high and low brain performance category (CPC) scoring subgroups. Weighted gene co-expression network analysis (WGCNA) was used to screen key gene modules and crossover genes in these datasets. The protein-protein interaction (PPI) network of crossover genes was constructed from the STRING database. Based on the PPI network, the most important hub genes were identified by the cytoHubba plugin of Cytoscape software. Eight hub genes (RPL27, EEF1B2, PFDN5, RBX1, PSMD14, HINT1, SNRPD2, and RPL26) were finally screened and validated, which were downregulated in the group with poor neurological prognosis. In addition, GSEA identified critical pathways associated with these genes. Finally, a Pearson correlation analysis showed that the mRNA expression of hub genes EEF1B2, PSMD14, RPFDN5, RBX1, and SNRPD2 were significantly and positively correlated with NDS scores in rats. Our work could provide comprehensive insights into understanding pathogenesis and potential new biomarkers for predicting neurological outcomes after cardiac arrest.
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Affiliation(s)
- Qiang Zhang
- Department of Emergency Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; (Q.Z.); (C.L.); (B.L.); (Y.L.); (J.C.); (C.W.)
| | - Chenyu Zhang
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; (C.Z.); (H.Z.); (H.W.); (S.L.)
| | - Cong Liu
- Department of Emergency Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; (Q.Z.); (C.L.); (B.L.); (Y.L.); (J.C.); (C.W.)
| | - Haohong Zhan
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; (C.Z.); (H.Z.); (H.W.); (S.L.)
| | - Bo Li
- Department of Emergency Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; (Q.Z.); (C.L.); (B.L.); (Y.L.); (J.C.); (C.W.)
| | - Yuanzhen Lu
- Department of Emergency Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; (Q.Z.); (C.L.); (B.L.); (Y.L.); (J.C.); (C.W.)
| | - Hongyan Wei
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; (C.Z.); (H.Z.); (H.W.); (S.L.)
| | - Jingge Cheng
- Department of Emergency Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; (Q.Z.); (C.L.); (B.L.); (Y.L.); (J.C.); (C.W.)
| | - Shuhao Li
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; (C.Z.); (H.Z.); (H.W.); (S.L.)
| | - Chuyue Wang
- Department of Emergency Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; (Q.Z.); (C.L.); (B.L.); (Y.L.); (J.C.); (C.W.)
| | - Chunlin Hu
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; (C.Z.); (H.Z.); (H.W.); (S.L.)
- Correspondence: (C.H.); (X.L.)
| | - Xiaoxing Liao
- Department of Emergency Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; (Q.Z.); (C.L.); (B.L.); (Y.L.); (J.C.); (C.W.)
- Correspondence: (C.H.); (X.L.)
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Krychtiuk KA, Fordyce CB, Hansen CM, Hassager C, Jentzer JC, Menon V, Perman SM, van Diepen S, Granger CB. Targeted temperature management after out of hospital cardiac arrest: quo vadis? EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:512-521. [PMID: 35579006 DOI: 10.1093/ehjacc/zuac054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
Targeted temperature management (TTM) has become a cornerstone in the treatment of comatose post-cardiac arrest patients over the last two decades. Belief in the efficacy of this intervention for improving neurologically intact survival was based on two trials from 2002, one truly randomized-controlled and one small quasi-randomized trial, without clear confirmation of that finding. Subsequent large randomized trials reported no difference in outcomes between TTM at 33 vs. 36°C and no benefit of TTM at 33°C as compared with fever control alone. Given that these results may help shape post-cardiac arrest patient care, we sought to review the history and rationale as well as trial evidence for TTM, critically review the TTM2 trial, and highlight gaps in knowledge and research needs for the future. Finally, we provide contemporary guidance for the use of TTM in daily clinical practice.
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Affiliation(s)
- Konstantin A Krychtiuk
- Duke Clinical Research Institute, Duke Health, 300 W Morgan Street, Durham, NC 27701, USA
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Carolina M Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah M Perman
- Department of Emergency Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sean van Diepen
- Canadian VIGOUR Center, University of Alberta, Edmonton, AB, Canada
- Department of Critical Care Medicine and Division of Cardiology, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke Health, 300 W Morgan Street, Durham, NC 27701, USA
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