Multiple cooling methods are available, including the administration of cold intravenous iv fluids. Therapeutic hypothermia after cardiac arrest t herapeutic hypothermia for comatose adults who have had an outofhospital cardiac arrest was recommended on the basis of results of clinical trials reported in 2002. National institute for health and care excellence 2011 therapeutic hypothermia following cardiac arrest ipg386. Relationship between time to target temperature and outcome in patients treated with therapeutic hypothermia after cardiac arrest.
Therapeutic hypothermia after inhospital cardiac arrest circulation. Induced hypothermia might benefit comatose adult patients with spontaneous circulation after outofhospital cardiac arrest from a nonshockable rhythm or cardiac arrest in hospital. Hessel ii, md, facs more than 210,000 inhospital cardiac arrests occur annually in the united states. Current guidelines recommend the use of therapeutic hypothermia in patients with inhospital cardiac arrest, even though its efficacy has been demonstrated only in randomized trials after outofhospital cardiac arrest. Therapeutic hypothermia after cardiac arrest ce article. Pdf importance despite evidence that therapeutic hypothermia improves. Formal guidelines recommend that therapeutic hypothermia be considered after inhospital cardiac arrest. Cardiac arrest and therapeutic hypothermia sciencedirect. Therapeutic hypothermia after cardiac arrest springerlink. Despite many years of research, outcome after cardiac arrest is dismal.
We aimed to determine the use of therapeutic hypothermia for adult in. Use of therapeutic hypothermia and outcomes following inhospital cardiac arrest. Recently it has been shown that induced hypothermia applied immediately after hospital arrival can improve survival with good neurologic outcome and is now a recommended therapy for patients resuscitated from cardiac arrest. The california technology assessment forum assesses the evidence for the use of mild therapeutic hypothermia in comatose patients after cardiac arrest. Factors include use of th after cardiac arrest, age, gender, year of admission, number of charlson.
Its sometimes used for people who have a cardiac arrest. Table 2 presents the odds ratio of factors predicting in. A knowledge translation collaborative to improve the use. Use of therapeutic hypothermia should include comatose survivors of cardiac arrest associated initially with nonshockable rhythms and shockable rhythms.
Does cooling hurt inhospital cardiac arrest outcomes. A metaanalysis of therapeutic hypothermia th after outofhospital cardiac arrest ohca concludes that it is associated with a survival and neuroprotective benefit, even when including patients with nonshockable rhythms, more lenient downtimes, unwitnessed arrest andor persistent shock after return of spontaneous circulation rosc. Mild therapeutic hypothermia mth has been shown in randomized, controlled trials rct to improve neurological outcomes in patients who suffer outofhospital cardiac arrest ohca from shockable rhythms. There was greatest support for a comparative trial of hypothermia versus normothermia. Therapeutic hypothermia after cardiac arrest jama jama. Among comatose children who survived inhospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a. In a trial conducted at 37 childrens hospitals, we compared two temperature interventions in children who had had inhospital cardiac arrest.
See also the thapcaoh study for analogous data regarding outofhospital pediatric cardiac arrest objectives. Clinicians guide to induced hypothermia after cardiac arrest. The lower level of evidence for use after cardiac arrest from nonshockable rhythms is acknowledged. Therapeutic hypothermia after cardiac arrest johns. Among these advances are the use of therapeutic hypothermia th and targeted temperature management ttm, along with other interventions to improve the care. Pdf therapeutic hypothermia after cardiac arrest researchgate. Confusion around therapeutic temperature management.
The authors discuss the efficacy of therapeutic hypothermia, indications and contraindications for its use, various induction methods, associated complications and ad verse effects, and nursing care specific to patients undergoing this procedure. Use of cold fluids in postcardiac arrest therapeutic. Therapeutic hypothermia is an effective treatment for neurological protection after outofhospital cardiac arrest, and may also be beneficial for inhospital cardiac arrest. Therapeutic hypothermia was found to significantly shorten icu stay and time of mechanical ventilation in survivors after outofhospital cardiac arrest. Is hypothermia harmful after inhospital cardiac arrest. Cardiac arrest results in over 500,000 deaths per year in north america alone. If targeted temperature management is used, what is the optimal. Lactate reflects hypoxic insult in many conditions and is considered as a prognosis factor.
Therapeutic hypothermia protocol for cardiac arrest. We aimed to determine the use of therapeutic hypothermia for. The incidences of bloodproduct use, infection, and serious adverse events, as well as 28day mortality, did not differ significantly between groups. The determination of coma patient prognosis after cardiac arrest has clinical, ethical and. Outcomes of mild therapeutic hypothermia after inhospital. Deyo comorbidities, hospital teaching status, and volume tercile of hospitals that performed therapeutic hypothermia. Investigators addressed the question of whether therapeutic hypothermia th is beneficial for comatose patients after inhospital cardiac arrest, using a large u. Outcomes in patients treated with therapeutic hypothermia. However, advances in cardiopulmonary resuscitation and postcardiac arrest care have improved outcomes in select cohorts of patients. University of texas health science center at houston j. Survey of the use of therapeutic hypothermia post cardiac. The brainpreserving cooling treatment known as therapeutic hypothermia is rarely being used in patients who suffer cardiac arrest while in the hospital, despite its proven potential to improve survival and neurological function, researchers from the perelman school of medicine at the university of pennsylvania report in the june issue of critical care medicine.
This nonrandomized, observational cohort study based on a large. Pdf use of therapeutic hypothermia after inhospital. For inhospital cardiac arrest, the use of therapeutic hypothermia was associated with poorer survival rates and worse neurologic outcomes, get with the guidelines registry data showed. We aimed to determine the use of therapeutic hypothermia for adult inhospital cardiac arrest, whether use has increased over time, and. Sixtynine percent of the cardiac arrests occurred out of the hospital. Although survivors of vf cardiac arrest have the most to gain from therapeutic hypothermia, some level 4 evidence suggests that survivors from outofhospital cardiac arrest of other causes may also benefit. A similar study of patients with inhospital cardiac arrest treated with therapeutic hypothermia reported that the target temperature was not achieved in 44. Allow a minimum of 72 hours from time of cardiac arrest before considering.
Association between therapeutic hypothermia and survival after in. Hypothermia for nonvf vt cardiac arrest th e evidence on whether use of mild therapeutic hypothermia could improve prognosis in comatose patients resuscitated from nonvfvt cardiac arrest is sparse. Once the heart starts beating again, healthcare providers use cooling devices to lower your body temperature for a short time. Md, phddepartment of critical care medicine, university of pittsburgh medical center, pa k. This exclusion was to ensure that events analyzed reflected outofhospital cardiac arrest, given the lack of trial evidence to support the use of therapeutic hypothermia for inhospital cardiac arrest. One such advance, therapeutic hypothermia, is neuroprotective and has been demonstrated to improve clinical outcomes in patients who remain unresponsive despite return of spontaneous circulation after arrhythmogenic cardiac arrest. Recognition of and response to acute illness in adults in hospital cg50.
Therapeutic hypothermia after inhospital cardiac arrest. Resuscitated cardiac arrest continues to carry a poor prognosis despite advances in medical care. Temporal trends in the use of therapeutic hypothermia for. Introduction induction of moderate hypothermia 28 32 8c before cardiac arrest has been used successfully since the 1950s to protect the brain against the global ischaemia that occurs during some openheart surgery. Use of therapeutic hypothermia after inhospital cardiac. Therapeutic hypothermia after cardiac arrest american nurse. Many inhospital cardiac arrests have noncardiac causes. National institute for health and care excellence 2007 acutely ill patients in hospital.
No benefit with hypothermia after cardiac arrest in children. Cardiac arrest happens when the heart suddenly stops beating. Therapeutic hypothermia protocol for cardiac arrest patient selection patients who present to the emergency department ed or critical care unit ccu after cardiac arrest in or out of hospital who have a return of spontaneous circulation rosc and have the following conditions should be considered for this protocol. These experiments approximated what occurs in cardiac arrest and predicted the clinical use of hypothermia in human medicine. There is evidence of the use of therapeutic hypothermia since the ancient. Therapeutic hypothermia after inhospital cardiac arrest a. There are no randomized trials of hypothermia for inhospital cardiac arrest, and the very few observational studies are too small or flawed to draw any conclusions. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia target temperature, 33. Even after blood flow is restored, however, secondary brain injury can occur if cerebral edema results from direct tissue injury or bloodbrain barrier. More than 210,000 inhospital cardiac arrests occur annually in the united states. The hyperion trial supports the use of therapeutic hypothermia in all patients in coma after outofhospital cardiac arrest and buttresses the 2015 international liaison committee on resuscitation guidelines, which recommend moderate therapeutic hypothermia for all patients with coma after successful resuscitation from cardiac arrest. Mortality after therapeutic hypothermia journal of.
Use of moderate therapeutic hypothermia th in comatose survivors after return of spontaneous circulation following outofhospital cardiac arrest oohca caused by ventricular fibrillation or pulseless ventricular tachycardia is recommended strongly by many professional organizations and societies. Use of hypothermia treatment in patients following cardiac arrest lessens the chance of ischemic brain damage and leads to improved neurological outcomes at 6 months. Conclusions and relevance among patients with inhospital cardiac arrest, use of therapeutic hypothermia compared with usual care was. The first inhuman study of hypothermia after cardiac arrest was performed in 1958 and suggested decreased mortality. This exceptional study included 19 patients resuscitated after perioperative cardiac arrest. Therapeutic hypothermia after outofhospital cardiac.
Use of moderate therapeutic hypothermia th in comatose survivors after return of spontaneous circulation following outofhospital cardiac arrest oohca. Pdf prognosis following outofhospital cardiac arrest is generally poor, which is mostly due to the severity of neuronal damage. Use of therapeutic hypothermia afterinhospital cardiac arrest. Cardiac arrest is a leading cause of death in north america, resulting in more than 330,000 deaths per year. Among more than 26,000 patients resuscitated after inhospital arrest, 6% received th.
The utility of mth after inhospital cardiac arrest ihca has not been as well studied. Among comatose children who survived inhospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. To evaluate the efficacy of therapeutic hypothermia compared to therapeutic normothermia at increasing 12 month survival rates in comatose infants and children who were resuscitated after an inhospital cardiac arrest. Therapeutic hypothermia also called targeted temperature management refers to deliberate reduction of the core body temperature, typically to a range of about 32 to 34 c 89. Therapeutic hypothermia after pediatric cardiac arrest in. Therapeutic hypothermia rarely used for inhospital. Association of serum lactate with outcome after outofhospital cardiac arrest treated with therapeutic hypothermia. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. Persistent coma is a common finding after cardiac arrest and has profound ethical and economic implications. Therapeutic hypothermia after cardiac arrest circulation. Hypothermia after outofhospital cardiac arrest was previously shown to be no better than normal body temperature, and now a new study shows the same result after inhospital arrest. Therapeutic hypothermia for inhospital cardiac arrest. Finally, we lack data on the temperature achieved among patients who were managed with therapeutic hypothermia to further inform the potential effects of the ttm trial on the approach to management of outofhospital cardiac arrest. History and current use of mild therapeutic hypothermia.
A total of 86% would randomise their patients into a randomised controlled trial rct of therapeutic hypothermia in cardiac arrest. Future analysis of trends in the use of therapeutic hypothermia for inhospital cardiac arrest could address this question. The rate of therapeutic hypothermia use after inhospital cardiac arrest and details about its implementation are unknown. Pdf temporal trends in the use of therapeutic hypothermia for. Orban jc1, novain m1, cattet f1, plattier r1, nefzaoui m1, hyvernat h2, raguin o3, kaidomar m4, kerever s5, ichai c1. Management hypothermia after inhospital cardiac arrest. Therapeutic hypothermia is recommended for comatose adults after witnessed outofhospital cardiac arrest, but data about this intervention in children are limited. Registres i revisions association of serum lactate with. Therapeutic hypothermia th has been part of the standard care of postresuscitation patients for more than a decade. Among patients with inhospital cardiac arrest, use of therapeutic hypothermia compared with usual care was associated with a lower likelihood.
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