Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Mar 2013
Determinants of Pneumonia Risk During Endovascular Hypothermia.
Therapeutic hypothermia is a promising neuroprotective therapy with multiple mechanisms of action. Previously, we demonstrated the feasibility of thrombolysis combined with endovascular hypothermia and an antishivering regimen, but pneumonia occurred more often in cooled patients. We sought to identify whether any factors could be identified that increased pneumonia risk. ⋯ In a group of hypothermia patients suffering a 50% reported incidence of pneumonia, we found no variables that explained risk other than baseline NIHSS. Future trials should include rigorous definitions of pneumonia and prespecified surveillance methods to minimize case ascertainment bias. Measures to prevent pneumonia are needed in all patients treated with hypothermia.
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Ther Hypothermia Temp Manag · Mar 2013
Successful Implementation of Comprehensive Packages of Postcardiac Arrest Care After Out-of-Hospital Cardiac Arrest: A Single Institution Experience in South Korea.
The survival rate among patients admitted to hospital after out-of-hospital cardiac arrest (OHCA) was generally poor. And the optimal hospital care for patients after OHCA is not exactly known because multiple organ systems are affected. We implemented comprehensive packages of postcardiac arrest care, including therapeutic hypothermia (TH) to improve outcomes in patients with successfully resuscitated from OHCA. ⋯ In the adjusted analysis, patients admitted during the intervention period demonstrated improved survival (odds ratio: 2.609, 95% confidence interval: 1.318-5.166) and had favorable neurologic outcomes (odds ratio: 3.568, 95% confidence interval: 1.224-10.399) compared with those admitted during the control period. Comprehensive packages of postcardiac arrest care can be successfully implemented in a tertiary teaching hospital. In addition, implementation of TH was associated with significant improvements in survival and neurologic outcomes after OHCA.
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Ther Hypothermia Temp Manag · Mar 2013
Therapeutic hypothermia for brain injury from near hanging: review of the literature.
Hanging, strangulation, and suffocation constitute the second most common cause of death by suicide in the United States after firearms. Near hanging is defined as an unsuccessful attempt at hanging. Victims of near hanging suffer from strangulation with cerebral ischemia and resultant reperfusion injury, irrespective of whether they had cardiac arrest or not. ⋯ Even though some studies showed that near-hanging victims who present comatose to the hospital can have good neurologic outcomes after supportive therapy alone, some patients are still left with a poor neurologic outcome, especially if they sustained cardiac arrest. Prospective studies are warranted to test the potential benefit of TH on neurologic outcome and survival in this patient population. Although it would be difficult to conduct such studies, we feel that the compelling case studies, anecdotal evidence, and extrapolated data support its use until more evidence can be obtained.
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Ther Hypothermia Temp Manag · Dec 2012
Drug-induced therapeutic hypothermia after asphyxial cardiac arrest in swine.
A feasibility study was performed to compare an investigational drug, HBN-1, to forced cooling to induce hypothermia after resuscitation in a translation model of asphyxial cardiac arrest in swine. Serum and cerebral spinal fluid neuron-specific enolase activity (sNSE and csfNSE) were measured after cardiac arrest as surrogate markers of brain injury. In a block design, swine resuscitated from 10 minutes of asphyxial cardiac arrest were infused intravenously with HBN-1 or iced saline vehicle (forced hypothermia [FH]) 5 to 45 minutes after return of spontaneous circulation (ROSC). ⋯ The time to reach target hypothermia after cardiac arrest was reduced by nearly 50% with HBN-1 compared to the FH method of inducing hypothermia. Moreover, surrogate biomarkers of brain injury were significantly reduced with HBN-1 as compared to FH. While HBN-1-induced hypothermia shows promise for being neuroprotective, survival studies are needed to confirm these preliminary findings.