Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jun 2012
Induction of a prolonged hypothermic state by drug-induced reduction in the thermoregulatory set-point.
The marked improvement in outcome following induction of hypothermia after cardiac arrest has spurred the search for better methods to induce cooling. A regulated decrease in core temperature mediated by a drug-induced reduction in the set point for thermoregulation may be an ideal means of inducing hypothermia. To this end, the exploratory drug HBN-1 was assessed as a means to induce mild and prolonged hypothermia. ⋯ HBN-1 infusion induced a mild and prolonged hypothermia in free moving, unanesthetized rats characterized by modulation of thermoeffectors to reduce heat gain and increase heat loss. HBN-1 thus appears to elicit regulated hypothermia and may provide a new method for achieving a prolonged state of therapeutic hypothermia.
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Ther Hypothermia Temp Manag · Jun 2012
Endovascular catheter as a rewarming method for accidental hypothermia.
The human body functions within a very narrow range of optimal core body temperature. Mechanisms are in place that enable it to thermoregulate despite large fluctuations in external temperature. Going beyond the normal physiologic range is poorly tolerated. ⋯ Warmed saline and vasopressors were started; an Icy catheter connected to a Zoll Coolgard was placed in the vena cava via the femoral vein and the patient was rewarmed at a rate of 1°C without complications. He was later transferred out of the coronary care unit hemodynamically stable. Although there are no clinical practice guidelines in place, severe hypothermia has been traditionally managed with invasive and aggressive rewarming techniques; endovascular catheters as an alternative for rapid and controlled rewarming may be a worthy and safe alternative to these more invasive procedures.
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Ther Hypothermia Temp Manag · Jun 2012
Initial clinical predictors of significant coronary lesions after resuscitation from cardiac arrest.
Urgent coronary angiography following cardiac arrest is an important consideration as part of a therapeutic hypothermia/postresuscitation care bundle. Few data exist to guide the selection of patients who should receive postarrest angiography. This investigation sought to evaluate patient-level variables on initial postarrest presentation and their association with significant coronary lesions on subsequent angiography. ⋯ Multivariable adjusted analysis demonstrated that significant lesions were associated with a prior known history of coronary disease and/or prior myocardial infarction (odds ratio [OR] 6.2, 95% confidence interval [CI] 1.6-24.4, p=0.009), and with initial rhythm of ventricular fibrillation/ventricular tachycardia (OR 2.9, 95% CI 1.1-7.7, p=0.033), but not with hypertension, tobacco use, age, or initial troponin measurements. Prior known history of coronary disease and a shockable arrest rhythm were associated with significant coronary lesions on subsequent angiography. Normal initial troponin values and younger age did not exclude clinically relevant lesions postarrest.
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Ther Hypothermia Temp Manag · Jun 2012
Post-cardiac arrest therapeutic hypothermia in New Jersey hospitals: analysis of adoption and implementation.
While national guidelines recommend the use of therapeutic hypothermia (TH) for the treatment of out-of-hospital cardiac arrest (OHCA), adoption of the technique has been slow. In addition, little is known about how TH is applied in practice. This study sought to characterize the adoption and implementation of TH by acute care hospitals in the state of New Jersey. ⋯ The vast majority of New Jersey hospitals are now organized to implement national TH guidelines for initial survivors of OHCA. However, limited volumes of OHCA cases per hospital and lack of uniformity on how the guidelines are implemented raise new questions about the effectiveness of current practice in postarrest care. More detailed analysis of TH volumes versus outcomes and comparative studies of TH techniques are required to optimize postarrest care.
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Ther Hypothermia Temp Manag · Jun 2012
Effects of different fluid regimes and desmopressin on uncontrolled hemorrhage during hypothermia in the rat.
Resuscitation with large volumes of crystalloids during traumatic hemorrhagic shock might increase the mortality by inducing rebleeding. However, few studies have addressed this problem during hypothermic conditions. Sixty-eight Sprague-Dawley rats were exposed to a standardized femoral artery injury and resuscitated with low (LRe), medium (MRe), or high (HRe) intensity using lactated Ringer's solution after being cooled to 30°C. ⋯ Overall, the mortality increased if rebleeding occurred (10/35 rebleeders died vs. 1/25 nonrebleeders, p=0.015). Liberal fluid administration increased the rebleeding volume while a trend toward higher mortality was seen with the restrictive fluid program. Desmopressin had no effect on the studied parameters.