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Beske RP, Obling LER, Bro-Jeppesen J, Nielsen N, Meyer MAS, Kjaergaard J, Johansson PI, Hassager C. The Effect of Targeted Temperature Management on the Metabolome Following Out-of-Hospital Cardiac Arrest. Ther Hypothermia Temp Manag 2023; 13:208-215. [PMID: 37219970 DOI: 10.1089/ther.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Targeted temperature management (TTM) may moderate the injury from out-of-hospital cardiac arrest. Slowing the metabolism has been a suggested effect. Nevertheless, studies have found higher lactate levels in patients cooled to 33°C compared with 36°C even days from TTM cessation. Larger studies have not been performed on the TTM's effect on the metabolome. Accordingly, to explore the effect of TTM, we used ultra-performance liquid-mass spectrometry in a substudy of 146 patients randomized in the TTM trial to either 33°C or 36°C for 24 hours and quantified 60 circulating metabolites at the time of hospital arrival (T0) and 48 hours later (T48). From T0 to T48, profound changes to the metabolome were observed: tricarboxylic acid (TCA) cycle metabolites, amino acids, uric acid, and carnitine species all decreased. TTM significantly modified these changes in nine metabolites (Benjamini-Hochberg corrected false discovery rate <0.05): branched amino acids valine and leucine levels dropped more in the 33°C arm (change [95% confidence interval]: -60.9 μM [-70.8 to -50.9] vs. -36.0 μM [-45.8 to -26.3] and -35.5 μM [-43.1 to -27.8] vs. -21.2 μM [-28.7 to -13.6], respectively), whereas the TCA metabolites including malic acid and 2-oxoglutaric acid remained higher for the first 48 hours (-7.7 μM [-9.7 to -5.7] vs. -10.4 μM [-12.4 to -8.4] and -3 μM [-4.3 to -1.7] vs. -3.7 μM [-5 to -2.3]). Prostaglandin E2 only dropped in the TTM 36°C group. The results show that TTM affects the metabolism hours after normothermia have been reached. Clinical Trial Number: NCT01020916.
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Affiliation(s)
- Rasmus Paulin Beske
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niklas Nielsen
- Department of Clinical Sciences at Helsingborg, Lund University, Lund, Sweden
| | | | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Pär Ingemar Johansson
- Department of Clinical Immunology, Center for Endotheliomics, CAG, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bro-Jeppesen J, Grejs AM, Andersen O, Jeppesen AN, Duez C, Kirkegaard H. Soluble Urokinase-Type Plasminogen Activator Receptor in Comatose Survivors After Out-of-Hospital Cardiac Arrest Treated with Targeted Temperature Management. Ther Hypothermia Temp Manag 2023. [PMID: 37910781 DOI: 10.1089/ther.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Exposure to whole-body ischemia/reperfusion after out-of-hospital cardiac arrest (OHCA) triggers a systemic inflammatory response where soluble urokinase plasminogen activator receptor (suPAR) is released. This study investigated serial levels of suPAR in differentiated target temperature management and the associations with mortality and 6-month neurological outcome. This is a single-center substudy of the randomized Targeted Temperature Management (TTM) for 24-hour versus 48-hour trial. In this analysis, we included 82 patients and measured serial levels of suPAR at 24, 48, and 72 hours after achievement of target temperature (32-34°C). We assessed all-cause mortality and neurological function evaluated by the Cerebral Performance Categories (CPC) at 6 months after OHCA. Levels of suPAR between TTH groups were evaluated in repeated measures mixed models. Mortality was assessed by the Kaplan-Meier method and serial measurements of suPAR (log2 transformed) were investigated by Cox proportional-hazards models. Good neurological outcome at 6 months was assessed by logistic regression analyses. Levels of suPAR were significantly different between TTH groups (pinteraction = 0.04) with the highest difference at 48 hours, 4.7 ng/mL (95% CI: 4.1-5.4 ng/mL) in the TTH24 group compared to 2.8 ng/mL (95% CI: 2.2-3.5 ng/mL) in the TTH48 group, p < 0.0001. Levels of suPAR above the median value were significantly associated with increased all-cause mortality at any time point (plog-rank<0.05). The interaction of suPAR levels and TTH group was not significant (pinteraction = NS). A twofold increase in levels of suPAR was significantly associated with a decreased odds ratio of a good neurological outcome in both unadjusted and adjusted analyses without interaction of TTH group (pinteraction = NS). Prolonged TTM of 48 hours versus 24 hours was associated with lower levels of suPAR. High levels of suPAR were associated with increased mortality and lower odds for good neurological outcome at 6 months with no significant interaction of TTH group.
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Affiliation(s)
- John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders M Grejs
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ove Andersen
- Department of Clinical Research and Emergency, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Anni N Jeppesen
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus, Denmark
| | - Christophe Duez
- Department of Otolaryngology, Goedstrup Hospital, Central Denmark Region, Glostrup, Denmark
| | - Hans Kirkegaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
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Blennow Nordström E, Vestberg S, Evald L, Mion M, Segerström M, Ullén S, Bro-Jeppesen J, Friberg H, Heimburg K, Grejs AM, Keeble TR, Kirkegaard H, Ljung H, Rose S, Wise MP, Rylander C, Undén J, Nielsen N, Cronberg T, Lilja G. Neuropsychological outcome after cardiac arrest: results from a sub-study of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial. Crit Care 2023; 27:328. [PMID: 37633944 PMCID: PMC10463667 DOI: 10.1186/s13054-023-04617-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Cognitive impairment is common following out-of-hospital cardiac arrest (OHCA), but the nature of the impairment is poorly understood. Our objective was to describe cognitive impairment in OHCA survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA. METHODS This was a prospective case-control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. At approximately 7 months post-event, we administered an extensive neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. RESULTS Of 184 eligible OHCA survivors, 108 were included, with 92 MI controls enrolled. Amongst OHCA survivors, 29% performed z-score ≤ - 1 (at least borderline-mild impairment) in ≥ 2 cognitive domains, 14% performed z-score ≤ - 2 (major impairment) in ≥ 1 cognitive domain while 54% performed without impairment in any domain. Impairment was most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = - 0.37, 95% confidence intervals [- 0.61, - 0.12]), verbal (MD = - 0.34 [- 0.62, - 0.07]), and visual/constructive functions (MD = - 0.26 [- 0.47, - 0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, executive functions (MD = - 0.44 [- 0.82, - 0.06]) were also worse following OHCA. Diabetes, symptoms of anxiety, depression, and fatigue were significantly associated with worse cognitive performance. CONCLUSIONS In our study population, cognitive impairment was generally mild following OHCA. OHCA survivors performed worse than MI controls in 3 of 6 domains. These results support current guidelines that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue. TRIAL REGISTRATION ClinicalTrials.gov, NCT03543371. Registered 1 June 2018.
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Affiliation(s)
- Erik Blennow Nordström
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden.
| | | | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Marco Mion
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Magnus Segerström
- Department of Neurology and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Friberg
- Intensive and Perioperative Care, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Malmö, Sweden
| | - Katarina Heimburg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Anders M Grejs
- Department of Intensive Care Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Hanna Ljung
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Sofia Rose
- Clinical Psychology, Cardiff and Vale University Health Board, NHS Wales, Cardiff, UK
| | - Matthew P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Christian Rylander
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Undén
- Intensive and Perioperative Care, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Malmö, Sweden
- Operation and Intensive Care, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Niklas Nielsen
- Anesthesiology and Intensive Care, Department of Clinical Sciences Lund, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Tobias Cronberg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Gisela Lilja
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
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Holgersson J, Meyer MAS, Dankiewicz J, Lilja G, Ullén S, Hassager C, Cronberg T, Wise MP, Bělohlávek J, Hovdenes J, Pelosi P, Erlinge D, Schrag C, Smid O, Brunetti I, Rylander C, Young PJ, Saxena M, Åneman A, Cariou A, Callaway C, Eastwood GM, Haenggi M, Joannidis M, Keeble TR, Kirkegaard H, Leithner C, Levin H, Nichol AD, Morgan MPG, Nordberg P, Oddo M, Storm C, Taccone FS, Thomas M, Bro-Jeppesen J, Horn J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher MJ, Friberg H, Nielsen N, Jakobsen JC. Hypothermic versus Normothermic Temperature Control after Cardiac Arrest. NEJM Evid 2022; 1:EVIDoa2200137. [PMID: 38319850 DOI: 10.1056/evidoa2200137] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Hypothermia versus Normothermia after Cardiac ArrestHolgersson et al. perform an individual patient data meta-analysis of the TTM and TTM2 trials of hypothermia after cardiac arrest and find no difference in 6-month mortality with hypothermia to 33°C versus normothermia.
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Affiliation(s)
- Johan Holgersson
- Anesthesiology and Intensive Care, Department of Clinical Sciences, Helsingborg Hospital Lund, Lund University, Lund, Sweden
| | | | - Josef Dankiewicz
- Cardiology, Department of Clinical Sciences, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Gisela Lilja
- Neurology, Department of Clinical Sciences, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen
| | - Tobias Cronberg
- Neurology, Department of Clinical Sciences, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Jan Bělohlávek
- Cardiovascular Medicine, Second Department of Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Hovdenes
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Rikshospitalet, Oslo
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, Scientific Institute for Research, Hospitalization and Healthcare for Oncology and Neurosciences, University of Genoa, Genoa, Italy
| | - David Erlinge
- Cardiology, Department of Clinical Sciences, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Claudia Schrag
- Intensive Care Department, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Ondrej Smid
- Cardiovascular Medicine, Second Department of Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Iole Brunetti
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, Scientific Institute for Research, Hospitalization and Healthcare for Oncology and Neurosciences, University of Genoa, Genoa, Italy
| | - Christian Rylander
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paul J Young
- Intensive Care Unit, Medical Research Institute of New Zealand, Wellington Hospital, Wellington, New Zealand
| | - Manoj Saxena
- Division of Critical Care and Trauma, George Institute for Global Health, Sydney
| | - Anders Åneman
- Department of Intensive Care, Liverpool Hospital, Sydney
| | - Alain Cariou
- Cochin University Hospital, Descartes University of Paris, Paris
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh
| | - Glenn M Eastwood
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Matthias Haenggi
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Joannidis
- Division of Intensive and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom
- Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Hans Kirkegaard
- Department of Clinical Medicine, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Christoph Leithner
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätzmedizin, Berlin
| | - Helena Levin
- Anesthesiology and Intensive Care, Department of Clinical Sciences, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Alistair D Nichol
- University College Dublin Clinical Research Centre, St. Vincent's University Hospital, Dublin
- School of Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Matt P G Morgan
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Per Nordberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm
| | - Mauro Oddo
- Adult Intensive Care Medicine Service, Neuroscience Critical Care Research Group, Vaud University Hospital Center, University of Lausanne, Lausanne, Switzerland
| | - Christian Storm
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels
| | - Matthew Thomas
- Department of Intensive Care, Bristol Royal Infirmary, Bristol, United Kingdom
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Center, Amsterdam
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen
| | - Michael Kuiper
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Tommaso Pellis
- Intensive Care Unit, Santa Maria degli Angeli, Pordenone, Italy
| | - Pascal Stammet
- Department of Intensive Care Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
- Department of Life Sciences and Medicine, Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Michael Jaeger Wanscher
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen
| | - Hans Friberg
- Anesthesia and Intensive Care, Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - Niklas Nielsen
- Anesthesiology and Intensive Care, Department of Clinical Sciences, Helsingborg Hospital Lund, Lund University, Lund, Sweden
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Center for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Beske RP, Bache S, Abild Stengaard Meyer M, Kjærgaard J, Bro-Jeppesen J, Obling L, Olsen MH, Rossing M, Nielsen FC, Møller K, Nielsen N, Hassager C. MicroRNA-9-3p: a novel predictor of neurological outcome after cardiac arrest. Eur Heart J Acute Cardiovasc Care 2022; 11:609-616. [PMID: 35695264 DOI: 10.1093/ehjacc/zuac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
AIMS Resuscitated out-of-hospital cardiac arrest (OHCA) patients who remain comatose after hospital arrival are at high risk of mortality due to anoxic brain injury. MicroRNA are small-non-coding RNA molecules ultimately involved in gene-silencing. They show promise as biomarkers, as they are stable in body fluids. The microRNA 9-3p (miR-9-3p) is associated with neurological injury in trauma and subarachnoid haemorrhage. METHODS AND RESULTS This post hoc analysis considered all 171 comatose OHCA patients from a single centre in the target temperature management (TTM) trial. Patients were randomized to TTM at either 33°C or 36°C for 24 h. MicroRNA-9-3p (miR-9-3p) was measured in plasma sampled at admission and at 28, 48, and 72 h. There were no significant differences in age, gender, and pre-hospital data, including lactate level at admission, between miR-9-3p level quartiles. miR-9-3p levels changed markedly following OHCA with a peak at 48 h. Median miR-9-3p levels between TTM 33°C vs. 36°C were not different at any of the four time points. Elevated miR-9-3p levels at 48 h were strongly associated with an unfavourable neurological outcome [OR: 2.21, 95% confidence interval (CI): 1.64-3.15, P < 0.0001). MiR-9-3p was inferior to neuron-specific enolase in predicting functional neurological outcome [area under the curve: 0.79 (95% CI: 0.71-0.87) vs. 0.91 (95% CI: 0.85-0.97)]. CONCLUSION MiR-9-3p is strongly associated with neurological outcome following OHCA, and the levels of miR-9-3p are peaking 48 hours following cardiac arrest.
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Affiliation(s)
- Rasmus Paulin Beske
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren Bache
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Centre for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Martin Abild Stengaard Meyer
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Laust Obling
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maria Rossing
- Centre for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen: Copenhagen, Denmark
| | | | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen: Copenhagen, Denmark
| | - Niklas Nielsen
- Department of Clinical Sciences at Helsingborg, Lund University, Lund, Sweden
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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6
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Paulin Beske R, Henriksen HH, Obling L, Kjærgaard J, Bro-Jeppesen J, Nielsen N, Johanson PI, Hassager C. Targeted plasma metabolomics in resuscitated comatose out-of-hospital cardiac arrest patients. Resuscitation 2022; 179:163-171. [PMID: 35753507 DOI: 10.1016/j.resuscitation.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Even if successfully resuscitated, mortality remains high due to ischemic and reperfusion injury (I/R). The oxygen deprivation leads to a metabolic derangement amplified upon reperfusion resulting in an uncontrolled generation of reactive oxygen species in the mitochondria triggering cell death mechanisms. The understanding of I/R injury in humans following OHCA remains sparse, with no existing treatment to attenuate the reperfusion injury. AIM To describe metabolic derangement in patients following resuscitated OHCA. METHODS Plasma from consecutive resuscitated unconscious OHCA patients drawn at hospital admission were analyzed using ultra-performance-liquid-mass-spectrometry. Sixty-one metabolites were prespecified for quantification and studied. RESULTS In total, 163 patients were included, of which 143 (88%) were men, and the median age was 62 years (53-68). All measured metabolites from the tricarboxylic acid (TCA) cycle were significantly higher in non-survivors vs. survivors (180-days survival). Hierarchical clustering identified four clusters (A-D) of patients with distinct metabolic profiles. Cluster A and B had higher levels of TCA metabolites, amino acids and acylcarnitine species compared to C and D. The mortality was significantly higher in cluster A and B (A:62% and B:59% vs. C:21 % and D:24%, p < 0.001). Cluster A and B had longer time to return of spontaneous circulation (A:33 min (21-43), B:27 min (24-35), C:18 min (13-28), and D:18 min (12-25), p < 0.001). CONCLUSION Circulating levels of metabolites from the TCA cycle best described the variance between survivors and non-survivors. Four different metabolic phenotypes with significantly different mortality were identified.
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Affiliation(s)
- Rasmus Paulin Beske
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hanne H Henriksen
- Center for Endotheliomics, CAG, Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Laust Obling
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niklas Nielsen
- Department of Clinical Sciences at Helsingborg, Lund University. Lund, Sweden
| | - Pär I Johanson
- Center for Endotheliomics, CAG, Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Grand J, Kjaergaard J, Hassager C, Møller JE, Bro-Jeppesen J. Comparing Doppler Echocardiography and Thermodilution for Cardiac Output Measurements in a Contemporary Cohort of Comatose Cardiac Arrest Patients Undergoing Targeted Temperature Management. Ther Hypothermia Temp Manag 2021; 12:159-167. [PMID: 34415801 DOI: 10.1089/ther.2021.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Measuring cardiac output is used to guide treatment during postresuscitation care. The aim of this study was to compare Doppler echocardiography (Doppler-CO) with thermodilution using pulmonary artery catheters (PAC-CO) for cardiac output estimation in a large cohort of comatose out-of-hospital cardiac arrest (OHCA) patients undergoing targeted temperature management (TTM). Single-center substudy of 141 patients included in the TTM trial randomly assigned to 33 or 36°C for 24 hours after OHCA. Per protocol, PAC-CO and Doppler-CO were measured simultaneously shortly after admission and again at 24 and 48 hours. Linear correlation was assessed between methods and positive predictive value (PPV) and negative predictive value (NPV) of Doppler to estimate low cardiac output (<3.5 L/min) was calculated. A total of 301 paired cardiac output measurements were available. Average cardiac output was 5.28 ± 1.94 L/min measured by thermodilution and 4.06 ± 1.49 L/min measured by Doppler with a mean bias of 1.22 L/min (limits of agreements -1.92 to 4.36 L/min). Correlation between methods was moderate (R2 = 0.36). Using PAC-CO as the gold standard, PPV of a low cardiac output measurement (<3.5 L/min) by Doppler was 33%. However, the NPV was 92%. Hypothermia at 33°C did not negatively affect the correlations of CO methods. In the lowest quartile of Doppler, 13% had elevated lactate (>2 mmol/L). In the lowest quartile of thermodilution, 36% had elevated lactate (>2 mmol/L). In ventilated OHCA patients, the two methods for estimating cardiac output correlated moderately and there was a consistent underestimation of Doppler-CO. Absolute cardiac output values from Doppler-CO should be interpreted with caution. However, Doppler can be used to exclude low cardiac output with high accuracy. TTM at 33°C did not negatively affect the correlation or bias of cardiac output measurements. ClinicalTrials.gov ID: NCT01020916.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Thomsen JH, Hassager C, Erlinge D, Nielsen N, Lindholm MG, Bro-Jeppesen J, Grand J, Pehrson S, Graff C, Køber LV, Kjaergaard J. Repolarization and ventricular arrhythmia during targeted temperature management post cardiac arrest. Resuscitation 2021; 166:74-82. [PMID: 34271131 DOI: 10.1016/j.resuscitation.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Targeted temperature management (TTM) following out-of-hospital cardiac arrest (OHCA) prolongs the QT-interval but our knowledge of different temperatures and risk of arrhythmia is incomplete. OBJECTIVE To assess whether the QTc, QT-peak (QTp) and T-peak to T-end interval (TpTe) may be useful markers of ventricular arrhythmia in contemporary post cardiac arrest treatment. METHODS An ECG-substudy of the TTM-trial (TTM at 33 °C vs. 36 °C) with serial ECGs from 680 (94%) patients. Bazett's (B) and Fridericia's (F) formula were used for heart rate correction of the QT, QTp and TpTe. Ventricular arrhythmia (VT/VF) were registered during the first three days of post cardiac arrest care. RESULTS The QT, QTc and QTp intervals were prolonged more at 33 °C compared to 36 °C and restored to similar and lower levels after rewarming. The TpTe-interval remained between 92-100 ms throughout TTM in both groups. The QTc intervals were associated with ventricular arrhythmia, but not after adjustment for cardiac arrest characteristics. The QTp-interval was not associated with risk of ventricular arrhythmia. Heart rate corrected TpTe-intervals were associated with higher risk of arrhythmia (Odds ratio (OR): TpTe(B): 1.12 (1.02-1.23, p = 0.01 TpTe(F): 1.12 (1.02-1.23, p = 0.02) per 20 ms). Further a prolonged TpTe-interval ≥ 90 ms was consistently associated with higher risk (ORadjusted: TpTe(B): 2.05 (1.25-3.37), p < 0.01, TpTe(F): 2.14 (1.32-3.49), p < 0.01). CONCLUSIONS TTM prolongs the QT-interval by prolongation of the QTp-interval without association to increased risk. The TpTe-interval is not significantly affected by core temperature, but heart rate corrected TpTe intervals are robustly associated with risk of ventricular arrhythmia. TRIAL REGISTRATION The TTM-trial is registered and accessible at ClinicalTrials.gov (Identifier: NCT01020916).
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Affiliation(s)
- Jakob Hartvig Thomsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Matias Greve Lindholm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Johannes Grand
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
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Bro-Jeppesen J, Jeppesen AN, Haugaard S, Troldborg A, Hassager C, Kjaergaard J, Kirkegaard H, Wanscher M, Hvas AM, Thiel S. The complement lectin pathway protein MAp19 and out-of-hospital cardiac arrest: Insights from two randomized clinical trials. European Heart Journal. Acute Cardiovascular Care 2020; 9:S145-S152. [DOI: 10.1177/2048872619870031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aim:
Activation of the complement system is known to be a potent inducer of systemic inflammation, which is an important component of post-cardiac arrest syndrome. Mannan-binding-lectin associated protein of 19 kDa (MAp19) is suggested to be a regulatory component of the lectin pathway of complement activation. The aims of this study were to describe serial levels of MAp19 protein in comatose survivors of out-of-hospital cardiac arrest (OHCA), to evaluate the effect of two different regimes of targeted temperature management and to investigate the possible association between levels of MAp19 and mortality.
Methods:
In this post-hoc study, we analysed data from two large randomized controlled studies: ‘Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest’ (TTM) and ‘Targeted temperature management for 48 versus 24 h and neurological outcome after out-of-hospital cardiac arrest’ (TTH). We measured serial levels of MAp19 in 240 patients within 72 h after OHCA and in 82 healthy controls. The effect of targeted temperature management on MAp19 levels was analysed according to temperature allocation in main trials.
Results:
MAp19 levels were significantly lower in OHCA patients within 48 h after OHCA (p-values <0.001) compared with healthy controls. A target temperature at 33°C compared with 36°C for 24 h was associated with significantly lower levels of MAp19 (–57 ng/mL (95% confidence interval (CI): –97 to −16 mg/mL), p=0.006). Target temperature at 33°C for 48 h compared with 24 h was not associated with a difference in MAp19 levels (–31 ng/mL (95% CI: –120 to 60 mg/mL), p=0.57). Low MAp19 levels at admission were associated with higher 30-day mortality (12% vs. 38%, plog-rank =0.0008), also in adjusted analysis (two-fold higher, hazard ratio =0.48 (95% CI: 0.31 to 0.75), p=0.001). Analysis of MAp19 levels at 24–72 h showed they were not associated with 30-day mortality.
Conclusion:
Survivors after OHCA have lower levels of MAp19 protein compared with healthy controls. A targeted temperature management at 33°C compared with 36°C was associated with significantly lower MAp19 levels, whereas target temperature at 33°C for 48 h compared with 24 h did not influence MAp19 protein levels. Low MAp19 levels at admission were independently associated with increased mortality.
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Affiliation(s)
- John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Anni Nørgaard Jeppesen
- Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Denmark
| | - Simon Haugaard
- Department of Clinical Biochemistry, Aarhus University Hospital, Denmark
| | | | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Hans Kirkegaard
- Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Denmark
- Research Centre for Emergency Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Denmark
| | - Michael Wanscher
- Department of Cardiothoracic Anaesthesia 4142, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Denmark
| | - Steffen Thiel
- Department of Biomedicine, Aarhus University, Denmark
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Grand J, Hassager C, Bro-Jeppesen J, Gustafsson F, Møller JE, Boesgaard S, Nielsen N, Kjaergaard J. Impact of Hypothermia on Oxygenation Variables and Metabolism in Survivors of Out-of-Hospital Cardiac Arrest Undergoing Targeted Temperature Management at 33°C Versus 36°C. Ther Hypothermia Temp Manag 2020; 11:170-178. [PMID: 32584698 DOI: 10.1089/ther.2020.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Targeted temperature management (TTM) exerts substantial impact on hemodynamic function in out-of-hospital cardiac arrest (OHCA) patients. Whole-body oxygen consumption (VO2) and delivery (DO2) have not previously been investigated in a clinical setting during TTM at different levels of temperature after OHCA. A substudy of 151 patients randomized at a single center in the TTM-trial, where patients were randomly assigned TTM at 33°C (TTM33) or 36°C (TTM36) for 24 hours. We calculated VO2 according to the principle of Fick (VO2 = cardiac output*arteriovenous oxygen content difference). DO2 was calculated as cardiac output*arterial oxygen content. Cardiac output was measured by pulmonary artery catheter with thermodilution. Arteriovenous oxygen content difference was calculated from arterial and mixed venous oxygen saturation and hemoglobin. Oxygen extraction ratio = VO2/DO2. At 24 hours, the VO2 was 169 ± 59 mL O2 per minute in TTM33 and 217 ± 53 mL O2 per minute in TTM36 (p < 0.0001). During 24 hours of TTM, the overall difference was 53 mL O2 minute (95% confidence interval [CI]: 31-74, pgroup < 0.0001). After rewarming at 36 and 48 hours, there was no difference in VO2 between the groups. DO2 was overall 277 mL O2 per minute (95% CI: 175-379, pgroup < 0.0001) higher in the TTM36-group during TTM. Oxygen extraction ratio during TTM was not significantly different between the two groups (2% [95% CI: -0.1 to 5, pgroup = 0.09]). VO2 during the first 36 hours after OHCA correlated significantly with temperature, and VO2 was 19 mL O2 per minute lower per degree reduction in temperature (95% CI: 15-22), p < 0.0001. TTM at 33°C compared to 36°C after OHCA is associated with significantly lower VO2 and DO2, however, oxygen extraction ratio was not significantly different. For each degree lower body temperature, the VO2 fell by 19 mL O2 per minute.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niklas Nielsen
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Grand J, Bro-Jeppesen J, Hassager C, Rundgren M, Winther-Jensen M, Thomsen JH, Nielsen N, Wanscher M, Kjærgaard J. Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest. J Crit Care 2019; 54:65-73. [DOI: 10.1016/j.jcrc.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/20/2023]
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Grand J, Hassager C, Bro-Jeppesen J, Wanscher M, Kjaergaard J. P6383Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. Low blood pressure during targeted temperature management (TTM) is associated with acute renal injury (AKI). The aim of this study is to test the hypothesis, that low cardiac output during TTM is associated with acute kidney injury after OHCA.
Methods
Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. Mean arterial pressure ≥65 mmHg and central venous pressure of 10 to 15 mmHg were hemodynamic treatment goals. Acute kidney injury (AKI) was the primary endpoint and was defined according to the KDIGO-criteria. Differences between groups were tested by repeated measurements mixed models.
Measurements and main results
Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. At admission, cardiac index was higher in the AKI-group (mean (confidence interval): 2.6 (2.2–3.0) L/min/m2 versus 2.2 (2.0–2.3) L/min/m2, p=0.003). During 24 hours of targeted temperature management, patients with AKI had increased heart rate (11 beats/min, pgroup<0.0001) and increased lactate (1 mmol/L, pgroup<0.0001) compared to patients without AKI. However, there was no overall difference in cardiac index (pgroup = 0.25) (Figure). In multivariate models, adjusting for potential confounders including targeted temperature, mean arterial pressure (odds ratio: 0.69 (0.50–0.96) per 5 mmHg increase, p=0.03), heart rate (1.04 (1.01–1.08) per beat/min increase, p=0.01) and lactate (1.59 (1.14–2.2) per mmol/L increase, p=0.006) were independently associated with AKI, but cardiac index remained unrelated with AKI.
Figure 1
Conclusions
Blood pressure, heart rate and lactate, but not cardiac output, during 24 hours of targeted temperature management were associated with renal injury in comatose OHCA-patients.
Acknowledgement/Funding
The research fund Gangstedfonden and the Research fund of Rigshospitalet has supported this study with unrestricted salary in Dr. Grand's PhD project.
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Affiliation(s)
- J Grand
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Bro-Jeppesen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Wanscher
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Anaesthesia, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Grand J, Kjaergaard J, Bro-Jeppesen J, Wanscher M, Hassager C. 5230Association of cardiac output during targeted temperature management with mortality after out-of-hospital cardiac arrest. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Myocardial dysfunction and low cardiac output are common after out-of-hospital cardiac arrest (OHCA) as part of the post-cardiac arrest syndrome. This study investigates the association of cardiac output during targeted temperature management (TTM) with mortality. We hypothesized that low cardiac output during TTM is associated with mortality.
Methods
In the TTM-trial, which randomly allocated patients to TTM of 33°C or 36°C for 24 hours, we prospectively and consecutively monitored 171 patients with protocolized measurements from pulmonary artery catheters (PAC). Clinical and hemodynamic variables were registered at pre-specified time points in addition to 30-day survival status. Lactate, heart rate and cardiac index were measured at 3 time-points during TTM and averaged. We defined low cardiac output as a cardiac index during TTM <2.4 l/min/m2 in the TTM36-group and <1.8 l/min/m2 in the TTM33-group, since hypothermia affects cardiac output. We further stratified patients according to serum lactate (above/below 2 mmol/L) and heart rate (above/below median, which was 65 beats/min.).
Results
Of 152 patients with available hemodynamic measurements, 71 (47%) had low cardiac output during TTM (TTM33: 38 (49%), TTM36: 33 (44%)). Low cardiac output was not associated with mortality in univariate analysis (hazard ratio (HR): 1.47 [0.83–2.59], p=0.19) or multivariate analysis adjusted for potential confounders (HRadjusted: 0.74 [0.38–1.44], p=0.37). Low cardiac output combined with HR>65 was associated with increased mortality (HR: 2.69 [1.51–4.79], p=0.0007) in univariate, but not in multivariate analysis (p=0.22) (Figure). Low cardiac output and HR<65 was associated with decreased mortality in multivariate analysis (HRadjusted: 0.36 [0.14–0.93], p=0.03). Low cardiac output and lactate>2mmol/L was associated with increased mortality (HR: 2.73 [1.49–4.99], p=0.001) in univariate, but not in multivariate analysis (p=0.53), whereas patients with low cardiac output and lactate<2mmol/L had low mortality (HRadjusted: 0.58 [0.27–1.24], p=0.16) compared to the rest of the population (Figure).
Figure 1
Conclusion
This study found, that a frequent symptom during TTM is low cardiac output, which was not associated with mortality. However, patients with low cardiac output combined with either increased lactate or heart rate seems to be a population at risk. Whether low cardiac output should be corrected by inotropes or mechanical support to reduce mortality remains to be studied in prospective trials, but the efficacy of goal-directed therapy to increase cardiac output during TTM may be modest, especially if lactate and heart rate are normal.
Acknowledgement/Funding
The research fund Gangstedfonden and the Research fund of Rigshospitalet has supported this study with unrestricted salary in Dr. Grand's PhD project.
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Affiliation(s)
- J Grand
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Bro-Jeppesen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Wanscher
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Anaesthesia, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Grand J, Lilja G, Kjaergaard J, Bro-Jeppesen J, Friberg H, Wanscher M, Cronberg T, Nielsen N, Hassager C. Arterial blood pressure during targeted temperature management after out-of-hospital cardiac arrest and association with brain injury and long-term cognitive function. Eur Heart J Acute Cardiovasc Care 2019; 9:S122-S130. [PMID: 31246109 DOI: 10.1177/2048872619860804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES During targeted temperature management after out-of-hospital cardiac arrest infusion of vasoactive drugs is often needed to ensure cerebral perfusion pressure. This study investigated mean arterial pressure after out-of-hospital cardiac arrest and the association with brain injury and long-term cognitive function. METHODS Post-hoc analysis of patients surviving at least 48 hours in the biobank substudy of the targeted temperature management trial with available blood pressure data. Patients were stratified in three groups according to mean arterial pressure during targeted temperature management (4-28 hours after admission; <70 mmHg, 70-80 mmHg, >80 mmHg). A biomarker of brain injury, neuron-specific enolase, was measured and impaired cognitive function was defined as a mini-mental state examination score below 27 in 6-month survivors. RESULTS Of the 657 patients included in the present analysis, 154 (23%) had mean arterial pressure less than 70 mmHg, 288 (44%) had mean arterial pressure between 70 and 80 mmHg and 215 (33%) had mean arterial pressure greater than 80 mmHg. There were no statistically significant differences in survival (P=0.35) or neuron-specific enolase levels (P=0.12) between the groups. The level of target temperature did not statistically significantly interact with mean arterial pressure regarding neuron-specific enolase (Pinteraction_MAP*TTM=0.58). In the subgroup of survivors with impaired cognitive function (n=132) (35%) mean arterial pressure during targeted temperature management was significantly higher (Pgroup=0.03). CONCLUSIONS In a large cohort of comatose out-of-hospital cardiac arrest patients, low mean arterial pressure during targeted temperature management was not associated with higher neuron-specific enolase regardless of the level of target temperature (33°C or 36°C for 24 hours). In survivors with impaired cognitive function, mean arterial pressure during targeted temperature management was significantly higher.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Denmark
| | - Gisela Lilja
- Skane University Hospital, Lund University, Sweden
| | | | | | - Hans Friberg
- Department of Intensive and Perioperative Care, Lund University, Sweden
| | - Michael Wanscher
- Department of Cardiothoracic Anesthesia, University of Copenhagen, Denmark
| | | | - Niklas Nielsen
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Sweden
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Grand J, Kjaergaard J, Nielsen N, Friberg H, Cronberg T, Bro-Jeppesen J, Karsdal MA, Nielsen HB, Frydland M, Henriksen K, Mattsson N, Zetterberg H, Hassager C. Serum tau fragments as predictors of death or poor neurological outcome after out-of-hospital cardiac arrest. Biomarkers 2019; 24:584-591. [PMID: 31017476 DOI: 10.1080/1354750x.2019.1609580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Anoxic brain injury is the primary cause of death after resuscitation from out-of-hospital cardiac arrest (OHCA) and prognostication is challenging. The aim of this study was to evaluate the potential of two fragments of tau as serum biomarkers for neurological outcome. Methods: Single-center sub-study of 171 patients included in the Target Temperature Management (TTM) Trial randomly assigned to TTM at 33 °C or TTM at 36 °C for 24 h after OHCA. Fragments (tau-A and tau-C) of the neuronal protein tau were measured in serum 24, 48 and 72 h after OHCA. The primary endpoint was neurological outcome. Results: Median (quartile 1 - quartile 3) tau-A (ng/ml) values were 58 (43-71) versus 51 (43-67), 72 (57-84) versus 71 (59-82) and 76 (61-92) versus 75 (64-89) for good versus unfavourable outcome at 24, 48 and 72 h, respectively (pgroup = 0.95). Median tau C (ng/ml) values were 38 (29-50) versus 36 (29-49), 49 (38-58) versus 48 (33-59) and 48 (39-59) versus 48 (36-62) (pgroup = 0.95). Tau-A and tau-C did not predict neurological outcome (area under the receiver-operating curve at 48 h; tau-A: 0.51 and tau-C: 0.51). Conclusions: Serum levels of tau fragments were unable to predict neurological outcome after OHCA.
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Affiliation(s)
- Johannes Grand
- a Department of Cardiology, Copenhagen University Hospital , Copenhagen , Denmark
| | - Jesper Kjaergaard
- a Department of Cardiology, Copenhagen University Hospital , Copenhagen , Denmark
| | - Niklas Nielsen
- b Department of Anesthesia and Intensive Care, Helsingborg Hospital , Helsingborg , Sweden
| | - Hans Friberg
- c Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skåne University Hospital , Lund , Sweden
| | | | - John Bro-Jeppesen
- a Department of Cardiology, Copenhagen University Hospital , Copenhagen , Denmark
| | | | | | - Martin Frydland
- a Department of Cardiology, Copenhagen University Hospital , Copenhagen , Denmark
| | - Kim Henriksen
- e Biomarkers & Research, Nordic Bioscience , Herlev , Denmark
| | - Niklas Mattsson
- f Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital , Lund , Sweden.,g Clinical Memory Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University , Lund , Sweden
| | - Henrik Zetterberg
- h Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal , Sweden.,i Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg , Mölndal , Sweden.,j UK Dementia Research Institute at UCL , London , UK.,k Department of Neurodegenerative Disease, UCL Institute of Neurology , London , UK
| | - Christian Hassager
- a Department of Cardiology, Copenhagen University Hospital , Copenhagen , Denmark
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Wiberg S, Stride N, Bro-Jeppesen J, Holmberg MJ, Kjærgaard J, Larsen S, Donnino MW, Hassager C, Dela F. Mitochondrial dysfunction in adults after out-of-hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care 2019; 9:S138-S144. [PMID: 30854867 DOI: 10.1177/2048872618814700] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND While preclinical studies suggest that mitochondria play a pivotal role in ischaemia-reperfusion injury, the knowledge of mitochondrial function in human out-of-hospital cardiac arrest remains scarce. The present study sought to compare oxidative phosphorylation capacity in skeletal muscle biopsies from out-of-hospital cardiac arrest patients to healthy controls. METHODS This was a substudy of a randomised trial comparing targeted temperature management at 33°C versus 36°C for out-of-hospital cardiac arrest patients. Skeletal muscle biopsies were obtained from adult resuscitated comatose out-of-hospital cardiac arrest patients 28 hours after initiation of targeted temperature management, i.e. at target temperature prior to rewarming, and from age-matched healthy controls. Mitochondrial function was analysed by high-resolution respirometry. Maximal sustained respiration through complex I, maximal coupled respiration through complex I and complex II and maximal electron transport system capacity was compared. RESULTS A total of 20 out-of-hospital cardiac arrest patients and 21 controls were included in the analysis. We found no difference in mitochondrial function between temperature allocations. We found no difference in complex I sustained respiration between out-of-hospital cardiac arrest and controls (23 (18-26) vs. 22 (19-26) pmol O2/mg/s, P=0.76), whereas coupled complex I and complex II respiration was significantly lower in out-of-hospital cardiac arrest patients versus controls (53 (42-59) vs. 64 (54-68) pmol O2/mg/s, P=0.01). Furthermore, electron transport system capacity was lower in out-of-hospital cardiac arrest versus controls (63 (51-69) vs. 73 (66-78) pmol O2/mg/s, P=0.005). CONCLUSIONS Mitochondrial oxidative phosphorylation capacity in skeletal muscle biopsies was reduced in out-of-hospital cardiac arrest patients undergoing targeted temperature management compared to age-matched, healthy controls. The role of mitochondria as risk markers and potential targets for post-resuscitation care remains unknown.
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Affiliation(s)
- Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, USA
| | - Nis Stride
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Mathias J Holmberg
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, USA
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Steen Larsen
- Center for Healthy Aging, University of Copenhagen, Denmark
- Clinical Research Centre, Medical University of Bialystok, Poland
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, USA
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, USA
| | | | - Flemming Dela
- Center for Healthy Aging, University of Copenhagen, Denmark
- Department of Geriatrics, Bispebjerg Hospital, Denmark
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Gilje P, Frydland M, Bro-Jeppesen J, Dankiewicz J, Friberg H, Rundgren M, Devaux Y, Stammet P, Al-Mashat M, Jögi J, Kjaergaard J, Hassager C, Erlinge D. The association between plasma miR-122-5p release pattern at admission and all-cause mortality or shock after out-of-hospital cardiac arrest. Biomarkers 2018; 24:29-35. [PMID: 30015516 DOI: 10.1080/1354750x.2018.1499804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Data suggests that the plasma levels of the liver-specific miR-122-5p might both be a marker of cardiogenic shock and a prognostic marker of out-of-hospital cardiac arrest (OHCA). Our aim was to characterize plasma miR-122-5p at admission after OHCA and to assess the association between miR-122-5p and relevant clinical factors such all-cause mortality and shock at admission after OHCA. METHODS In the pilot trial, 10 survivors after OHCA were compared to 10 age- and sex-matched controls. In the main trial, 167 unconscious survivors of OHCA from the Targeted Temperature Management (TTM) trial were included. RESULTS In the pilot trial, plasma miR-122-5p at admission after OHCA was 400-fold elevated compared to controls. In the main trial, plasma miR-122-5p at admission was independently associated with lactate and bystander cardiopulmonary resuscitation. miR-122-5p at admission was not associated with shock at admission (p = 0.14) or all-cause mortality (p = 0.35). Target temperature (33 °C vs 36 °C) was not associated with miR-122-5p levels at any time point. CONCLUSIONS After OHCA, miR-122-5p demonstrated a marked acute increase in plasma and was independently associated with lactate and bystander resuscitation. However, miR-122-5p at admission was not associated with all-cause mortality or shock at admission.
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Affiliation(s)
- Patrik Gilje
- a Department of Cardiology, Clinical Sciences , Lund University , Lund , Sweden
| | - Martin Frydland
- b The Heart Centre, Department of Cardiology , Copenhagen University Hospital , Copenhagen , Denmark
| | - John Bro-Jeppesen
- b The Heart Centre, Department of Cardiology , Copenhagen University Hospital , Copenhagen , Denmark
| | - Josef Dankiewicz
- c Department of Intensive and Perioperative Care, Clinical Sciences , Lund University , Lund , Sweden
| | - Hans Friberg
- c Department of Intensive and Perioperative Care, Clinical Sciences , Lund University , Lund , Sweden
| | - Malin Rundgren
- c Department of Intensive and Perioperative Care, Clinical Sciences , Lund University , Lund , Sweden
| | - Yvan Devaux
- d Cardiovascular Research Unit , Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - Pascal Stammet
- e The Medical Department, National Rescue Services , Luxembourg, Luxembourg
| | - Mariam Al-Mashat
- f Department of Clinical Physiology, Clinical Sciences , Lund University , Lund , Sweden
| | - Jonas Jögi
- f Department of Clinical Physiology, Clinical Sciences , Lund University , Lund , Sweden
| | - Jesper Kjaergaard
- b The Heart Centre, Department of Cardiology , Copenhagen University Hospital , Copenhagen , Denmark
| | - Christian Hassager
- b The Heart Centre, Department of Cardiology , Copenhagen University Hospital , Copenhagen , Denmark
| | - David Erlinge
- a Department of Cardiology, Clinical Sciences , Lund University , Lund , Sweden
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Westhall E, Rosén I, Rundgren M, Bro-Jeppesen J, Kjaergaard J, Hassager C, Lindehammar H, Horn J, Ullén S, Nielsen N, Friberg H, Cronberg T. Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest. Clin Neurophysiol 2018; 129:1660-1668. [DOI: 10.1016/j.clinph.2018.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 01/30/2023]
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Westhall E, Rosén I, Rundgren M, Bro-Jeppesen J, Kjaergaard J, Hassager C, Horn J, Lindehammar H, Ullén S, Nielsen N, Friberg H, Cronberg T. Platform Session – Electroencephalography/Epilepsy: Temporal development of cEEG patterns as predictors of prognosis after cardiac arrest. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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20
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Salam I, Thomsen JH, Kjaergaard J, Bro-Jeppesen J, Frydland M, Winther-Jensen M, Køber L, Wanscher M, Hassager C, Søholm H. Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management. SCAND CARDIOVASC J 2018; 52:133-140. [PMID: 29553891 DOI: 10.1080/14017431.2018.1450991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM). DESIGN Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002-2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI). RESULTS A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p < .001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p < .001, witnessed: 79% vs. 90%, p < .001, bystander CPR: 47% vs. 63%, p < .001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2-2.9), p < .01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55-1.2), p = .34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present. CONCLUSION A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm.
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Affiliation(s)
- Idrees Salam
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.,b Department of Anaesthesiology , Central Denmark Regional Hospital Horsens , Horsens , Denmark
| | - Jakob Hartvig Thomsen
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Jesper Kjaergaard
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - John Bro-Jeppesen
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Martin Frydland
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Matilde Winther-Jensen
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lars Køber
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Michael Wanscher
- c Department of Thoracic Anaesthesiology, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Christian Hassager
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Helle Søholm
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.,d Department of Cardiology , Zealand University Hospital , Roskilde , Denmark
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Lilja G, Nielsen N, Bro-Jeppesen J, Dunford H, Friberg H, Hofgren C, Horn J, Insorsi A, Kjaergaard J, Nilsson F, Pelosi P, Winters T, Wise MP, Cronberg T. Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2018; 11:e003566. [DOI: 10.1161/circoutcomes.117.003566] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Gisela Lilja
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Niklas Nielsen
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - John Bro-Jeppesen
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Hannah Dunford
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Hans Friberg
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Caisa Hofgren
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Janneke Horn
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Angelo Insorsi
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Jesper Kjaergaard
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Fredrik Nilsson
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Paolo Pelosi
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Tineke Winters
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Matt P. Wise
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
| | - Tobias Cronberg
- From the Department of Clinical Sciences (G.L., T.C.) and Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine (N.N., H.F.), Skane University Hospital, Lund University, Sweden; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.B.-J., J.K.); Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom (H.D., M.P.W.); Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska
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Bro-Jeppesen J, Johansson PI, Kjaergaard J, Wanscher M, Ostrowski SR, Bjerre M, Hassager C. Level of systemic inflammation and endothelial injury is associated with cardiovascular dysfunction and vasopressor support in post-cardiac arrest patients. Resuscitation 2017; 121:179-186. [DOI: 10.1016/j.resuscitation.2017.09.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/17/2017] [Accepted: 09/22/2017] [Indexed: 01/06/2023]
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Winther-Jensen M, Hassager C, Kjaergaard J, Bro-Jeppesen J, Thomsen JH, Lippert FK, Køber L, Wanscher M, Søholm H. Women have a worse prognosis and undergo fewer coronary angiographies after out-of-hospital cardiac arrest than men. European Heart Journal: Acute Cardiovascular Care 2017; 7:414-422. [DOI: 10.1177/2048872617696368] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Out-of-hospital cardiac arrest is more often reported in men than in women. Objectives: We aimed to assess sex-related differences in post-resuscitation care; especially with regards to coronary angiography, percutaneous coronary intervention, mortality and functional status after out-of-hospital cardiac arrest. Methods: We included 704 consecutive adult out-of-hospital cardiac arrest-patients with cardiac aetiology in the Copenhagen area from 2007–2011. Utstein guidelines were used for the pre-hospital data. Vital status and pre-arrest comorbidities were acquired from Danish registries and review of patient charts. Logistic regression was used to assess differences in functional status and use of post-resuscitation care. Cox regression was used to assess differences in 30-day mortality. We used ‘smcfcs’ and ‘mice’ imputation to handle missing data. Results: Female sex was associated with higher 30-day mortality after adjusting for age and comorbidity (hazard ratio (HR): 1.42, confidence interval (CI): 1.13–1.79, p<0.01), this was not significant when adjusting for primary rhythm (HR: 1.12, CI: 0.88–1.42, p=0.37). Women less frequently received coronary angiography <24 h in multiple regression after out-of-hospital cardiac arrest (odds ratio (OR)CAG=0.55, CI: 0.31–0.97, p=0.041), however no difference in percutaneous coronary intervention was found (ORPCI=0.55, CI: 0.23–1.36, p=0.19). Coronary artery bypass grafting was less often performed in women (ORCABG: 0.10, CI: 0.01–0.78, p=0.03). There was no difference in functional status at discharge between men and women ( p=1). Conclusion: Female sex was not significantly associated with higher mortality when adjusting for confounders. Women less often underwent coronary angiography and coronary artery bypass grafting, but it is not clear whether this difference can be explained by other factors, or an actual under-treatment in women.
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Affiliation(s)
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jakob H Thomsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Michael Wanscher
- Department of Thoracic Anaesthesiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
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Wiberg S, Hassager C, Stammet P, Winther-Jensen M, Thomsen JH, Erlinge D, Wanscher M, Nielsen N, Pellis T, Åneman A, Friberg H, Hovdenes J, Horn J, Wetterslev J, Bro-Jeppesen J, Wise MP, Kuiper M, Cronberg T, Gasche Y, Devaux Y, Kjaergaard J. Single versus Serial Measurements of Neuron-Specific Enolase and Prediction of Poor Neurological Outcome in Persistently Unconscious Patients after Out-Of-Hospital Cardiac Arrest - A TTM-Trial Substudy. PLoS One 2017; 12:e0168894. [PMID: 28099439 PMCID: PMC5242419 DOI: 10.1371/journal.pone.0168894] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/07/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Prediction of neurological outcome is a crucial part of post cardiac arrest care and prediction in patients remaining unconscious and/or sedated after rewarming from targeted temperature management (TTM) remains difficult. Current guidelines suggest the use of serial measurements of the biomarker neuron-specific enolase (NSE) in combination with other predictors of outcome in patients admitted after out-of-hospital cardiac arrest (OHCA). This study sought to investigate the ability of NSE to predict poor outcome in patients remaining unconscious at day three after OHCA. In addition, this study sought to investigate if serial NSE measurements add incremental prognostic information compared to a single NSE measurement at 48 hours in this population. METHODS This study is a post-hoc sub-study of the TTM trial, randomizing OHCA patients to a course of TTM at either 33°C or 36°C. Patients were included from sites participating in the TTM-trial biobank sub study. NSE was measured at 24, 48 and 72 hours after ROSC and follow-up was concluded after 180 days. The primary end point was poor neurological function or death defined by a cerebral performance category score (CPC-score) of 3 to 5. RESULTS A total of 685 (73%) patients participated in the study. At day three after OHCA 63 (9%) patients had died and 473 (69%) patients were not awake. In these patients, a single NSE measurement at 48 hours predicted poor outcome with an area under the receiver operating characteristics curve (AUC) of 0.83. A combination of all three NSE measurements yielded the highest discovered AUC (0.88, p = .0002). Easily applicable combinations of serial NSE measurements did not significantly improve prediction over a single measurement at 48 hours (AUC 0.58-0.84 versus 0.83). CONCLUSION NSE is a strong predictor of poor outcome after OHCA in persistently unconscious patients undergoing TTM, and NSE is a promising surrogate marker of outcome in clinical trials. While combinations of serial NSE measurements may provide an increase in overall prognostic information, it is unclear whether actual clinical prognostication with low false-positive rates is improved by application of serial measurements in persistently unconscious patients. The findings of this study should be confirmed in another prospective cohort. TRIAL REGISTRATION NCT01020916.
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Affiliation(s)
- Sebastian Wiberg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pascal Stammet
- Department of Anaesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Michael Wanscher
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niklas Nielsen
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Tommaso Pellis
- Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy
| | - Anders Åneman
- Department of Intensive Care, Liverpool hospital, Sydney, New South Wales, Australia
| | - Hans Friberg
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Jan Hovdenes
- Department of Anaesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthew P. Wise
- Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Michael Kuiper
- Department of Intensive Care, Leeuwarden Medical Center, Leeuwarden, The Netherlands
| | - Tobias Cronberg
- Lund University, Skane University Hospital, Department of Clinical Sciences, Neurology, Lund, Sweden
| | - Yvan Gasche
- Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland
| | - Yvan Devaux
- Cardiovascular Research Unit, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Grand J, Thomsen JH, Kjaergaard J, Nielsen N, Erlinge D, Wiberg S, Wanscher M, Bro-Jeppesen J, Hassager C. Prevalence and Prognostic Implications of Bundle Branch Block in Comatose Survivors of Out-of-Hospital Cardiac Arrest. Am J Cardiol 2016; 118:1194-1200. [PMID: 27553102 DOI: 10.1016/j.amjcard.2016.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022]
Abstract
This study reports the prevalence and prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in the admission electrocardiogram (ECG) of comatose survivors of out-of-hospital cardiac arrest (OHCA). The present study is part of the predefined electrocardiographic substudy of the prospective randomized target temperature management trial, which found no benefit of targeting 33°C over 36°C in terms of outcome. Six-hundred eighty-two patients were included in the substudy. An admission ECG, which defined the present study population, was available in 602 patients (88%). These ECGs were stratified by the presence of LBBB, RBBB, or no-BBB (reference) on admission. End points were mortality and neurologic outcome 6 months after OHCA. RBBB was present in 79 patients (13%) and LBBB in 65 patients (11%), and the majority of BBBs (92%) had resolved 4 hours after admission. RBBB was associated with significantly higher 6 months mortality (RBBB: hazard ratio [HR]unadjusted 1.78, 95% confidence interval [CI] 1.30 to 2.43; LBBB: HRunadjusted 1.26, 95% CI 0.87 to 1.81), but this did not reach a level of significance in the adjusted model (HRadjusted 1.33, 95% CI 0.94 to 1.87). Similar findings were seen for neurologic outcome in the unadjusted and adjusted analyses. RBBB was further independently associated with higher odds of unfavorable neurologic outcome (RBBB: adjusted odds ratio 1.97, 95% CI 1.05 to 3.71). In conclusion, BBBs after OHCA were transient in most patients, and RBBB was directly associated with higher mortality and independently associated with higher odds of unfavorable neurologic outcome. RBBB is seemingly an early indicator of an unfavorable prognosis after OHCA.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Michael Wanscher
- Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Bro-Jeppesen J, Johansson PI, Hassager C, Wanscher M, Ostrowski SR, Bjerre M, Kjaergaard J. Endothelial activation/injury and associations with severity of post-cardiac arrest syndrome and mortality after out-of-hospital cardiac arrest. Resuscitation 2016; 107:71-9. [DOI: 10.1016/j.resuscitation.2016.08.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/31/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022]
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Frydland M, Kjaergaard J, Erlinge D, Stammet P, Nielsen N, Wanscher M, Pellis T, Friberg H, Hovdenes J, Horn J, Wetterslev J, Thomsen JH, Bro-Jeppesen J, Winther-Jensen M, Wise MP, Kuiper M, Cronberg T, Gasche Y, Devaux Y, Åneman A, Hassager C. Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome. Am J Cardiol 2016; 118:998-1005. [PMID: 27614855 DOI: 10.1016/j.amjcard.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 12/01/2022]
Abstract
N-terminal pro-B-type natriuretic (NT-proBNP) is expressed in the heart and brain, and serum levels are elevated in acute heart and brain diseases. We aimed to assess the possible association between serum levels and neurological outcome and death in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Of the 939 comatose OHCA patients enrolled and randomized in the Targeted Temperature Management (TTM) trial to TTM at 33°C or 36°C for 24 hours, 700 were included in the biomarker substudy. Of these, 647 (92%) had serum levels of NT-proBNP measured 24, 48, and 72 hours after return of spontaneous circulation (ROSC). Neurological outcome was evaluated by the Cerebral Performance Category (CPC) score and modified Rankin Scale (mRS) at 6 months. Six hundred thirty-eight patients (99%) had serum NT-proBNP levels ≥125 pg/ml. Patients with TTM at 33°C had significantly lower NT-proBNP serum levels (median 1,472 pg/ml) than those in the 36°C group (1,914 pg/ml) at 24 hours after ROSC, p <0.01 but not at 48 and 72 hours. At 24 hours, an increase in NT-proBNP quartile was associated with death (Plogrank <0.0001). In addition, NT-proBNP serum levels > median were independently associated with poor neurological outcome (odds ratio, ORCPC 2.02, CI 1.34 to 3.05, p <0.001; ORmRS 2.28, CI 1.50 to 3.46, p <0.001) adjusted for potential confounders. The association was diminished at 48 and 72 hours after ROSC. In conclusion, NT-proBNP serum levels are increased in comatose OHCA patients. Furthermore, serum NT-proBNP levels are affected by level of TTM and are associated with death and poor neurological outcome.
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Affiliation(s)
- Martin Frydland
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Pascal Stammet
- Department of Anaesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg
| | - Niklas Nielsen
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Michael Wanscher
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tommaso Pellis
- Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy
| | - Hans Friberg
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jan Hovdenes
- Department of Anaesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
| | - Jakob H Thomsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthew P Wise
- Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Michael Kuiper
- Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands
| | - Tobias Cronberg
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yvan Gasche
- Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland
| | - Yvan Devaux
- Laboratory of Cardiovascular Research, Luxembourg Institute of Health, Luxembourg
| | - Anders Åneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, The Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
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28
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Bakkestrøm R, Andersen MJ, Ersbøll M, Bro-Jeppesen J, Gustafsson F, Køber L, Hassager C, Møller JE. Early changes in left atrial volume after acute myocardial infarction. Relation to invasive hemodynamics at rest and during exercise. Int J Cardiol 2016; 223:717-722. [PMID: 27573595 DOI: 10.1016/j.ijcard.2016.08.228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise. The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides. METHODS 62 patients with left ventricle ejection fraction (LVEF)≥45%, diastolic E/e'>8 and LA volume index >34ml/m2 within 48h of MI were enrolled. After 1 and 4months blood sampling, echocardiography and right heart catheterization were performed during exercise test. RESULTS LA remodeling was considered in patients with a change from mild (35-41ml/m2), to severe (>48ml/m2) dilatation after 4months (Found in 22 patients (35%)). Patients with LA remodeling were characterized by lower a' (1month 8.9±2.0 vs. 10.4±2.5cm/s, p=0.002; 4month 8.8±2.0 vs. 10.4±2.4cm/s, p=0.007) and higher MR-proANP (1month 162±64 vs. 120±44pg/l, p=0.005; 4months 175±48 vs. 129±56pg/l, p=0.002). With exercise, pulmonary artery pressure, right atrial pressure and pulmonary capillary wedge pressure increased markedly in all patients. There were however, no significant differences in filling pressure at rest or during exercise irrespective of whether LA remodeling occurred. CONCLUSION Contrary to our hypothesis early LA dilatation after MI was weakly associated with resting and exercise induced changes in LA pressure overload. The dilatation was however associated with lower e' and higher MR-proANP.
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Affiliation(s)
- Rine Bakkestrøm
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Mads J Andersen
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Mads Ersbøll
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - John Bro-Jeppesen
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Finn Gustafsson
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Lars Køber
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Christian Hassager
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark
| | - Jacob E Møller
- From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
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29
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Thomsen JH, Kjaergaard J, Graff C, Pehrson S, Erlinge D, Wanscher M, Køber L, Bro-Jeppesen J, Søholm H, Winther-Jensen M, Hassager C. Ventricular ectopic burden in comatose survivors of out-of-hospital cardiac arrest treated with targeted temperature management at 33°C and 36°C. Resuscitation 2016; 102:98-104. [DOI: 10.1016/j.resuscitation.2016.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/18/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
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30
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Bro-Jeppesen J, Kjaergaard J, Thiel S, Jensenius JC, Bjerre M, Wanscher M, Christensen JV, Hassager C. Influence of mannan-binding lectin and MAp44 on outcome in comatose survivors of out-of-hospital cardiac arrest. Resuscitation 2016; 101:27-34. [DOI: 10.1016/j.resuscitation.2016.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/13/2016] [Indexed: 01/19/2023]
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31
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Thomsen JH, Nielsen N, Hassager C, Wanscher M, Pehrson S, Køber L, Bro-Jeppesen J, Søholm H, Winther-Jensen M, Pellis T, Kuiper M, Erlinge D, Friberg H, Kjaergaard J. Bradycardia During Targeted Temperature Management. Crit Care Med 2016; 44:308-18. [DOI: 10.1097/ccm.0000000000001390] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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32
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Bro-Jeppesen J, Kjaergaard J, Stammet P, Nielsen N, Hassager C. Reply to Letter: ‘Corticosteroids and inflammation after cardiac arrest’. Resuscitation 2016; 99:e9. [DOI: 10.1016/j.resuscitation.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/01/2022]
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33
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Kjaergaard J, Nielsen N, Winther-Jensen M, Wanscher M, Pellis T, Kuiper M, Hartvig Thomsen J, Wetterslev J, Cronberg T, Bro-Jeppesen J, Erlinge D, Friberg H, Søholm H, Gasche Y, Horn J, Hovdenes J, Stammet P, Wise MP, Åneman A, Hassager C. Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest. Resuscitation 2015; 96:310-6. [DOI: 10.1016/j.resuscitation.2015.06.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/18/2015] [Accepted: 06/23/2015] [Indexed: 01/24/2023]
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34
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Bro-Jeppesen J, Kjaergaard J, Stammet P, Wise MP, Hovdenes J, Åneman A, Horn J, Devaux Y, Erlinge D, Gasche Y, Wanscher M, Cronberg T, Friberg H, Wetterslev J, Pellis T, Kuiper M, Nielsen N, Hassager C. Predictive value of interleukin-6 in post-cardiac arrest patients treated with targeted temperature management at 33 °C or 36 °C. Resuscitation 2015; 98:1-8. [PMID: 26525271 DOI: 10.1016/j.resuscitation.2015.10.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/28/2015] [Accepted: 10/10/2015] [Indexed: 12/12/2022]
Abstract
AIM Post-cardiac arrest syndrome (PCAS) is characterized by systemic inflammation, however data on the prognostic value of inflammatory markers is sparse. We sought to investigate the importance of systemic inflammation, assessed by interleukin-6 (IL-6) in comatose survivors of out-of-hospital cardiac arrest. METHODS A total of 682 patients enrolled in the Target Temperature Management (TTM) trial, surviving >24h with available IL-6 data were included. IL-6 was measured on days 1, 2 and 3 after return of spontaneous circulation. Severity of PCAS was assessed daily by the Sequential Organ Failure Assessment score. Survival status was recorded at 30 days. RESULTS High levels of IL-6 at day 1-3 (all p<0.0001) were independently associated with severity of PCAS with no interaction of target temperature (all p=NS). IL-6 levels did not differ between temperature groups (p(interaction)=0.99). IL-6 levels at day 2 (p<0.0001) and day 3 (p<0.0001) were associated with crude mortality. Adjusted Cox proportional-hazards analysis showed that a two-fold increase of IL-6 levels at day 2 (HR=1.15 (95% CI: 1.07-1.23), p=0.0002) and day 3 (HR=1.18 (95% CI: 1.09-1.27), p<0.0001) were associated with mortality. IL-6 levels at day 3 had the highest discriminative value in predicting mortality (AUC=0.66). IL-6 did not significantly improve 30-day mortality prediction compared to traditional prognostic factors (p=0.08). CONCLUSIONS In patients surviving >24h following cardiac arrest, IL-6 levels were significantly elevated and associated with severity of PCAS with no significant influence of target temperature. High IL-6 levels were associated with increased mortality. Measuring levels of IL-6 did not provide incremental prognostic value.
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Affiliation(s)
- John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Rigshospitalet University Hospital, Copenhagen, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Pascal Stammet
- Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg
| | - Matthew P Wise
- Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Jan Hovdenes
- Department of Anesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anders Åneman
- Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands
| | - Yvan Devaux
- Laboratory of Cardiovascular Research, Luxembourg Institute of Health, Luxembourg
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
| | - Yvan Gasche
- Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland
| | - Michael Wanscher
- Department of Cardiothoracic Anesthesiology, The Heart Centre, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Tobias Cronberg
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Hans Friberg
- Department of Anesthesia and Intensive Care, Lund University, Lund, Sweden
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
| | - Tommaso Pellis
- Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy
| | - Michael Kuiper
- Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet University Hospital, Copenhagen, Denmark
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35
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Jacob M, Hassager C, Bro-Jeppesen J, Ostrowski SR, Thomsen JH, Wanscher M, Johansson PI, Winther-Jensen M, Kjærgaard J. The effect of targeted temperature management on coagulation parameters and bleeding events after out-of-hospital cardiac arrest of presumed cardiac cause. Resuscitation 2015; 96:260-7. [PMID: 26362487 DOI: 10.1016/j.resuscitation.2015.08.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/19/2015] [Accepted: 08/23/2015] [Indexed: 02/08/2023]
Abstract
AIMS Targeted temperature management (TTM) is part of the standard treatment of comatose patients after out-of-hospital cardiac arrest (OHCA) to attenuate neurological injury. In other clinical settings, hypothermia promotes coagulopathy leading to an increase in bleeding and thrombosis tendency. Thus, concern has been raised as to whether TTM can be applied safely, as acute myocardial infarction requiring primary percutaneous coronary intervention (PCI) with the need of effective antiplatelet therapy is frequent following OHCA. This study investigated the influence of TTM at 33 or 36°C on various laboratory and coagulation parameters. METHODS AND RESULTS In this single-center predefined substudy of the TTM trial, 171 patients were randomized to TTM at either 33 or 36°C in the postresuscitation phase. The two subgroups were compared regarding standard laboratory coagulation parameters, thrombelastography (TEG), bleeding, and stent thrombosis events. Platelet counts were lower in the TTM33-group compared to TTM36 (p=0.009), but neither standard coagulation nor TEG-parameters showed any difference between the groups. TEG revealed a normocoagulable state in the majority of patients, while approximately 20% of the population presented as hypercoagulable. Adverse events included 38 bleeding events, one stent thrombosis, and one reinfarction, with no significant difference between the groups. CONCLUSIONS There was no evidence supporting the assumption that TTM at 33°C was associated with impaired hemostasis or increased the frequency of adverse bleeding and thrombotic events compared to TTM at 36°C. We found that TTM at either temperature can safely be applied in the postresuscitation phase after acute myocardial infarction and primary PCI.
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Affiliation(s)
- Marrit Jacob
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Sisse R Ostrowski
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Michael Wanscher
- Department of Cardiothoracic Anaesthesia, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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36
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Winther-Jensen M, Kjaergaard J, Hassager C, Bro-Jeppesen J, Nielsen N, Lippert FK, Køber L, Wanscher M, Søholm H. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile. Int J Cardiol 2015; 201:616-23. [PMID: 26340128 DOI: 10.1016/j.ijcard.2015.08.143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES We aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥80) to assess whether resuscitation and post resuscitation care should be avoided. METHODS During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). RESULTS 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n=558) were octogenarians/nonagenarians. 166 (30% of all octogenarians with resuscitation attempted) octogenarians were successfully resuscitated compared to 830 (43% with resuscitation attempted) patients <80 years. 30-day mortality in octogenarians was significantly higher after adjustment for prognostic factors (HR=1.61 CI: 1.22-2.13, p<0.001). Octogenarians received fewer coronary angiographies (CAG) (14 vs. 37%, p<0.001), and had lower odds of receiving CAG by multivariate logistic regression (OR: 0.19, CI: 0.08-0.44, p<0.001). A favorable neurological outcome (CPC 1/2) in survivors to discharge was found in 70% (n=26) of octogenarians compared to 86% (n=317, p=0.03) in the younger patients. CONCLUSION OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding resuscitation and post resuscitation care in octogenarians does not seem justified.
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Affiliation(s)
- Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Freddy K Lippert
- Emergency Medical Services, The Capital Region of Denmark, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Michael Wanscher
- Department of Thoracic Anesthesiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Helle Søholm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
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37
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Bro-Jeppesen J, Kjaergaard J, Wanscher M, Nielsen N, Friberg H, Bjerre M, Hassager C. Reply to Letter: 'Can therapeutic hypothermia of 33°C itself not modulate inflammatory response after out-of-hospital cardiac arrest?'. Resuscitation 2015; 92:e3-4. [PMID: 25979158 DOI: 10.1016/j.resuscitation.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Affiliation(s)
- John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Michael Wanscher
- Department of Cardiothoracic Anaesthesia, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden
| | - Hans Friberg
- Department of Anesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mette Bjerre
- The Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
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Salam I, Hassager C, Thomsen JH, Langkjær S, Søholm H, Bro-Jeppesen J, Bang L, Holmvang L, Erlinge D, Wanscher M, Lippert FK, Køber L, Kjaergaard J. Editor’s Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction? European Heart Journal: Acute Cardiovascular Care 2015; 5:317-26. [DOI: 10.1177/2048872615585519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Idrees Salam
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Sandra Langkjær
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Helle Søholm
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lia Bang
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lene Holmvang
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Sweden
| | - Michael Wanscher
- Department of Cardiothoracic Anaesthesia 4142, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | - Lars Køber
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
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Søholm H, Kjaergaard J, Bro-Jeppesen J, Hartvig-Thomsen J, Lippert F, Køber L, Nielsen N, Engsig M, Steensen M, Wanscher M, Karlsen FM, Hassager C. Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2015; 8:268-76. [DOI: 10.1161/circoutcomes.115.001767] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/30/2015] [Indexed: 12/20/2022]
Abstract
Background—
Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest.
Methods and Results—
Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment–elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002–2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (
P
<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64–0.96;
P
=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2–2.5]), temporary pacemaker (OR, 6.4 [2.2–19]), vasoactive agents (OR, 1.5 [1.1–2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3–22] and 3.8 [2.5–5.7]), neurophysiological examination (OR, 1.8 [1.3–2.6]), and brain computed tomography (OR, 1.9 [1.4–2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0–15]), had an echocardiography (OR, 2.8 [2.1–3.7]), and survivors more often had implantable cardioverter defibrillator’s implanted (OR, 2.1 [1.2–3.6]).
Conclusions—
Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment–elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.
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Affiliation(s)
- Helle Søholm
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Jesper Kjaergaard
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - John Bro-Jeppesen
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Jakob Hartvig-Thomsen
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Freddy Lippert
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Lars Køber
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Niklas Nielsen
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Magaly Engsig
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Morten Steensen
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Michael Wanscher
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Finn Michael Karlsen
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
| | - Christian Hassager
- From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte
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Johansson PI, Bro-Jeppesen J, Kjaergaard J, Wanscher M, Hassager C, Ostrowski SR. Sympathoadrenal activation and endothelial damage are inter correlated and predict increased mortality in patients resuscitated after out-of-hospital cardiac arrest. a post Hoc sub-study of patients from the TTM-trial. PLoS One 2015; 10:e0120914. [PMID: 25789868 PMCID: PMC4366381 DOI: 10.1371/journal.pone.0120914] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/28/2015] [Indexed: 12/22/2022] Open
Abstract
Objective Sympathoadrenal activation and endothelial damage are hallmarks of acute critical illness. This study investigated their association and predictive value in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods Post-hoc analysis of patients included at a single site in The Targeted Temperature Management at 33 degrees versus 36 degrees after Cardiac Arrest (TTM) trial. The main study reported similar outcomes with targeting 33 versus 36 degrees. TTM main study ClinicalTrials.gov: NCT01020916. One hundred sixty three patients resuscitated from OHCA were included at a single site ICU. Blood was sampled a median 135 min (Inter Quartile Range (IQR) 103-169) after OHCA. Plasma catecholamines (adrenaline, noradrenaline) and serum endothelial biomarkers (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin) were measured at admission (immediately after randomization). We had access to data on demography, medical history, characteristics of the OHCA, patients and 180-day outcome. Results Adrenaline and noradrenaline correlated positively with syndecan-1 and thrombomodulin i.e., biomarkers reflecting endothelial damage (both p<0.05). Overall 180-day mortality was 35%. By Cox analyses, plasma adrenaline, serum sE-selectin, reflecting endothelial cell activation, and thrombomodulin levels predicted mortality. However, thrombomodulin was the only biomarker independently associated with mortality after adjusting for gender, age, rhythm (shockable vs. non-shockable), OHCA to return of spontaneous circulation (ROSC) time, shock at admission and ST elevation myocardial infarction (30-day Hazards Ratio 1.71 (IQR 1.05-2.77), p=0.031 and 180-day Hazards Ratio 1.65 (IQR 1.03-2.65), p=0.037 for 2-fold higher thrombomodulin levels). Conclusions Circulating catecholamines and endothelial damage were intercorrelated and predicted increased mortality. Interventions aiming at protecting and/or restoring the endothelium may be beneficial in OHCA patients.
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Affiliation(s)
- Pär I. Johansson
- Section for Transfusion Medicine Capital Region Blood Bank, Rigshospitalet, Copenhagen, Capital Region, Denmark
- Department of Surgery and Division of Acute Care Surgery, Centre for Translational Injury Research (CeTIR) at University of Texas Medical School at Houston, Houston, Texas, United States
- * E-mail:
| | - John Bro-Jeppesen
- Department of Cardiology, Rigshospitalet, Copenhagen, Capital Region, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, Copenhagen, Capital Region, Denmark
| | - Michael Wanscher
- Department of Cardiothoracic Anesthesiology The Heart Center, Rigshospitalet, Copenhagen, Capital Region, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Capital Region, Denmark
| | - Sisse R. Ostrowski
- Section for Transfusion Medicine Capital Region Blood Bank, Rigshospitalet, Copenhagen, Capital Region, Denmark
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41
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Thomsen JH, Hassager C, Bro-Jeppesen J, Køber L, Boesgaard S, Møller JE, Nielsen N, Wanscher M, Kjærgaard J. Legislation hampers medical research in acute situations. Dan Med J 2015; 62:A5037. [PMID: 25748868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Informed consent in incapacitated adults is permitted in the form of proxy consent by both the patients' closest relative (next of kin, NOK) and general practitioner (GP). In research in acute situations not involving pharmaceuticals, Danish legislation allows for randomisation and subsequent proxy consent, as soon as possible. The aim of this study was to describe the delay associated with obtaining consent and to assess whether consent from NOK or GP/Danish Health and Medicines Authority is obtained with delays beyond the intervention. METHODS In a prospective study, 171 comatose out-of-hospital cardiac arrest (OHCA) patients were randomised to targeted temperature management. Patients were randomised before NOK could be informed, and proxy consent was obtained as soon as possible. Written consent from NOK and GP were our study data. RESULTS We obtained all legally required consent: 169 cases of consent were obtained from NOK, two patients gave consent before NOK, in no cases was consent denied by the proxy. Consent from NOK was obtained with a median delay of zero days (interquartile range (IQR): 0-1, max. 128 days). Delay from NOK consent to GP consent was a median of nine days (IQR: 6-23, max. 527 days). CONCLUSION NOK fully accepted participation in a clinical trial after OHCA with short delays in consent. Consent from GPs was associated with long delays beyond the intervention, which make GPs less appropriate for proxy consent of incapacitated adults in acute situations. The Ethics Committees' approval of the trial justified by their competence and authority, combined with the NOK´s insight into the patient's wishes may be a relevant and feasible alternative to the current consent procedure. FUNDING This work was supported by the European Regional Development Fund through the Interreg IV A OKS programme (NYPS ID: 167157) with regards to authors JHT, CH, NN and JK. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Jakob Hartvig Thomsen
- Hjertemedicinsk Klinik B, 2142, Hjertecentret, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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42
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Lilja G, Nielsen N, Friberg H, Horn J, Kjaergaard J, Nilsson F, Pellis T, Wetterslev J, Wise MP, Bosch F, Bro-Jeppesen J, Brunetti I, Buratti AF, Hassager C, Hofgren C, Insorsi A, Kuiper M, Martini A, Palmer N, Rundgren M, Rylander C, van der Veen A, Wanscher M, Watkins H, Cronberg T. Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C versus 36°C. Circulation 2015; 131:1340-9. [PMID: 25681466 DOI: 10.1161/circulationaha.114.014414] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Target temperature management is recommended as a neuroprotective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors have not been investigated sufficiently. The primary aim of this study was to evaluate whether a target temperature of 33°C compared with 36°C was favorable for cognitive function; the secondary aim was to describe cognitive impairment in cardiac arrest survivors in general. METHODS AND RESULTS Study sites included 652 cardiac arrest survivors originally randomized and stratified for site to temperature control at 33°C or 36°C within the Target Temperature Management trial. Survival until 180 days after the arrest was 52% (33°C, n=178/328; 36°C, n=164/324). Survivors were invited to a face-to-face follow-up, and 287 cardiac arrest survivors (33°C, n=148/36°C, n=139) were assessed with tests for memory (Rivermead Behavioural Memory Test), executive functions (Frontal Assessment Battery), and attention/mental speed (Symbol Digit Modalities Test). A control group of 119 matched patients hospitalized for acute ST-segment-elevation myocardial infarction without cardiac arrest performed the same assessments. Half of the cardiac arrest survivors had cognitive impairment, which was mostly mild. Cognitive outcome did not differ (P>0.30) between the 2 temperature groups (33°C/36°C). Compared with control subjects with ST-segment-elevation myocardial infarction, attention/mental speed was more affected among cardiac arrest patients, but results for memory and executive functioning were similar. CONCLUSIONS Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when a temperature of 33°C and 36°C was targeted. Cognitive impairment detected in cardiac arrest survivors was also common in matched control subjects with ST-segment-elevation myocardial infarction not having had a cardiac arrest. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01946932.
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Affiliation(s)
- Gisela Lilja
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.).
| | - Niklas Nielsen
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Hans Friberg
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Janneke Horn
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Jesper Kjaergaard
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Fredrik Nilsson
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Tommaso Pellis
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Jørn Wetterslev
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Matt P Wise
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Frank Bosch
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - John Bro-Jeppesen
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Iole Brunetti
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Azul Forti Buratti
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Christian Hassager
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Caisa Hofgren
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Angelo Insorsi
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Michael Kuiper
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Alice Martini
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Nicki Palmer
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Malin Rundgren
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Christian Rylander
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Annelou van der Veen
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Michael Wanscher
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Helen Watkins
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
| | - Tobias Cronberg
- From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.)
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Ostenfeld S, Lindholm MG, Kjaergaard J, Bro-Jeppesen J, Møller JE, Wanscher M, Hassager C. Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction. Resuscitation 2014; 87:57-62. [PMID: 25475249 DOI: 10.1016/j.resuscitation.2014.11.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/20/2014] [Accepted: 11/13/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA). BACKGROUND Despite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known. METHODS AND RESULTS In a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9mmol/l (SD 6) vs. 6mmol/l (SD 4) p<0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR)=1.02 [CI 1.00-1.03], p=0.01) and lactate at admission (HR=1.06 [CI 1.03-1.09], p<0.001), but not OHCA (HR=1.1 [CI 0.8-1.4], p=NS) was associated with mortality. In multivariate analysis, only age (HR=1.02 [CI 1.01-1.04], p=0.003) and lactate level at admission (HR=1.06 [1.03-1.09], p<0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p=NS. CONCLUSION OHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.
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Affiliation(s)
- Sarah Ostenfeld
- Department of Thoracic Anaesthesia, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark.
| | - Matias Greve Lindholm
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | | | - Michael Wanscher
- Department of Thoracic Anaesthesia, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark
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Søholm H, Kjaergaard J, Thomsen JH, Bro-Jeppesen J, Lippert FK, Køber L, Wanscher M, Hassager C. Myocardial infarction is a frequent cause of exercise-related resuscitated out-of-hospital cardiac arrest in a general non-athletic population. Resuscitation 2014; 85:1612-8. [DOI: 10.1016/j.resuscitation.2014.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/25/2014] [Accepted: 06/22/2014] [Indexed: 11/16/2022]
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Søholm H, Kjær TW, Kjaergaard J, Cronberg T, Bro-Jeppesen J, Lippert FK, Køber L, Wanscher M, Hassager C. Prognostic value of electroencephalography (EEG) after out-of-hospital cardiac arrest in successfully resuscitated patients used in daily clinical practice. Resuscitation 2014; 85:1580-5. [DOI: 10.1016/j.resuscitation.2014.08.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/11/2014] [Accepted: 08/22/2014] [Indexed: 11/17/2022]
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Bro-Jeppesen J, Kjaergaard J, Wanscher M, Nielsen N, Friberg H, Bjerre M, Hassager C. The inflammatory response after out-of-hospital cardiac arrest is not modified by targeted temperature management at 33°C or 36°C. Resuscitation 2014; 85:1480-7. [DOI: 10.1016/j.resuscitation.2014.08.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/30/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
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Andersen MJ, Ersbøll M, Bro-Jeppesen J, Møller JE, Hassager C, Køber L, Borlaug BA, Goetze JP, Gustafsson F. Relationships between biomarkers and left ventricular filling pressures at rest and during exercise in patients after myocardial infarction. J Card Fail 2014; 20:959-67. [PMID: 25285749 DOI: 10.1016/j.cardfail.2014.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased pulmonary capillary wedge pressure (PCWP) is an independent prognostic predictor after myocardial infarction (MI), but PCWP is difficult to assess noninvasively in subjects with preserved ejection fraction (EF). We hypothesized that biomarkers would provide information regarding PCWP at rest and during exercise in subjects with preserved EF after MI. METHODS AND RESULTS Seventy-four subjects with EF >45% and recent MI underwent right heart catheterization at rest and during a symptom-limited semisupine cycle exercise test with simultaneous echocardiography. Plasma samples were collected at rest for assessment of midregional pro-A-type natriuretic peptide (MR-proANP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), copeptin, and midregional pro-adrenomedullin (MR-proADM). Plasma levels of MR-proANP and PCWP were associated at rest (r = 0.33; P = .002) and peak exercise (r = 0.35; P = .002) as well as with changes in PCWP (r = 0.26; P = .03). Plasma levels of NT-proBNP and PCWP were weakly associated at rest (r = 0.23; P = .03) and peak exercise (r = 0.28; P = .02) but not with changes in PCWP (r = 0.20; P = .09). In a multivariable analysis, plasma levels of MR-proANP remained associated with rest and exercise PCWP (P < .01), whereas NT-proBNP did not. Plasma levels of Gal-3, copeptin, and MR-proADM were not associated with PCWP at rest or peak exercise. CONCLUSIONS In subjects recovering from an acute MI with preserved EF, plasma levels of natriuretic peptides, particularly MR-proANP, are associated with filling pressures at rest and during exercise.
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Affiliation(s)
- Mads J Andersen
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Mads Ersbøll
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jens P Goetze
- Department of Biochemistry, Rigshospitalet and University of Aarhus, Aarhus, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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48
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Bro-Jeppesen J, Hassager C, Wanscher M, Østergaard M, Nielsen N, Erlinge D, Friberg H, Køber L, Kjaergaard J. Targeted Temperature Management at 33°C Versus 36°C and Impact on Systemic Vascular Resistance and Myocardial Function After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2014; 7:663-72. [DOI: 10.1161/circinterventions.114.001556] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- John Bro-Jeppesen
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Christian Hassager
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Michael Wanscher
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Morten Østergaard
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Hans Friberg
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Lars Køber
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Jesper Kjaergaard
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
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Annborn M, Bro-Jeppesen J, Nielsen N, Ullén S, Kjaergaard J, Hassager C, Wanscher M, Hovdenes J, Pellis T, Pelosi P, Wise MP, Cronberg T, Erlinge D, Friberg H. The association of targeted temperature management at 33 and 36 °C with outcome in patients with moderate shock on admission after out-of-hospital cardiac arrest: a post hoc analysis of the Target Temperature Management trial. Intensive Care Med 2014; 40:1210-9. [DOI: 10.1007/s00134-014-3375-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/10/2014] [Indexed: 12/22/2022]
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Thomsen JH, Kjærgaard J, Hassager C, Graff C, Hansen J, Worbech T, Jensen JH, Bro-Jeppesen J, Pehrson S. [New studies question the cardiac safety of conducted electrical weapons]. Ugeskr Laeger 2014; 176:1178-1181. [PMID: 25765125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Conducted electrical weapons (CEW) were invented in the 1970s and are now widely used by more than 16,000 military and law enforcement agencies worldwide. Recent studies have sug-gested that a causal relation of cardiac arrest in humans and utilization of CEW may exist and cardiac capture and fatal arrhythmia have been documented in animal studies. We believe, based on current knowledge, that CEW use may have caused human fatalities. Users should be aware of potential serious side effects and be able to provide basic life support.
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