Clinical Trial of Induced Hypothermia in Comatose Survivors of Out-of-Hospital Cardiac Arrest☆,☆☆,★
Section snippets
INTRODUCTION
Patients who remain unconscious after resuscitation from out-of-hospital cardiac arrest have a poor prognosis.1 It is believed that part of the anoxic neurologic injury occurs after the return of spontaneous circulation (ROSC),2 and considerable research has been conducted on therapies that might ameliorate this “reperfusion injury.”3, 4, 5
The findings of animal studies of cerebral anoxia have suggested that moderate induced hypothermia (IH), applied shortly after ROSC, may improve neurologic
MATERIALS AND METHODS
Dandenong Hospital is a 380-bed teaching hospital in the south-east metropolitan area of Melbourne, Victoria, Australia, with a catchment population of approximately 400,000. The EMS system is two tiered: ambulances carry either qualified ambulance officers with defibrillation skills or paramedics with advanced life support (ALS) skills. Paramedics perform all ALS procedures according to protocol, without on-line medical direction. Patients who do not demonstrate ROSC despite ALS in the field
RESULTS
The clinical details of both groups of patients are shown in Table 1. These data suggest that the two groups were comparable at study entry, with no significant differences in age, sex, or time from collapse to ROSC. The two groups had similar incidences of witnessed collapse, bystander CPR, and VF as the presenting rhythm. The depth of coma in the ED, as shown by the number of patients with unreactive pupils and lack of response to a painful stimulus, suggests that the degree of anoxic brain
DISCUSSION
Patients who sustain prehospital cardiac arrest have a poor prognosis, with only 2% to 10% returning home to independent living.13 Many patients remain unconscious after ROSC, and this anoxic brain injury accounts for almost half of the deaths that occur after hospital admission.1, 14, 15
Evidence suggests that part of the neurologic injury (the so-called reperfusion injury) occurs after ROSC, and this has been extensively reviewed.2, 3, 4, 5, 16 The major mechanism of injury is thought to be
References (48)
- et al.
Assessment of neurological prognosis of comatose survivors of cardiac arrest
Lancet
(1994) Cerebral resuscitation after cardiac arrest: Research initiatives and future directions
Ann Emerg Med
(1993)- et al.
Assessment of outcome after severe brain damage: A practical scale
Lancet
(1975) - et al.
Global brain ischemia and reperfusion
Ann Emerg Med
(1996) - et al.
Cerebral and systemic arteriovenous oxygen monitoring after cardiac arrest: Inadequate cerebral oxygen delivery
Resuscitation
(1994) - et al.
Delayed and prolonged post-ischemic hypothermia is neuroprotective in the gerbil
Brain Res
(1994) - et al.
Quality-of-life and formal functional testing of survivors of out-of-hospital cardiac arrest correlates poorly with traditional neurologic outcome scales
Ann Emerg Med
(1996) - et al.
Cerebral resuscitation from cardiac arrest: Pathophysiological mechanisms
Crit Care Med
(1996) - et al.
Cerebral resuscitation after cardiac arrest: Treatment potentials
Crit Care Med
(1996) - et al.
Current research directions in cerebral resuscitation after cardiac arrest
Curr Opin Crit Care
(1995)
Mild hypothermic cardiopulmonary resuscitation improves outcome after cardiac arrest in dogs
Crit Care Med
Multifaceted cerebral resuscitation in cardiac arrest dog outcome model: Exploratory Series II. Hypothermia, hypertension, thiopental anaesthesia, phenytoin, steroid, hemodilution and normocapnea
Crit Care Med
Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: A prospective, randomized study
Crit Care Med
Improved cerebral resuscitation from cardiac arrest in dogs, with mild hypothermia plus blood flow promotion
Stroke
Clinical, electrophysiologic and hemodynamic profiles of patients resuscitated from prehospital cardiac arrest
Am J Med
Hypothermia after cardiac arrest
Crit Care Med
Cardiac arrest and resuscitation: A tale of 29 cities
Ann Emerg Med
A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest
N Engl J Med
Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital
Br Heart J
Acute brain swelling after out-of-hospital cardiac arrest: Pathogenesis and outcome
Crit Care Med
Improving survival from sudden cardiac arrest: The “chain of survival” concept
Circulation
Predicting survival from out-of-hospital cardiac arrest: A graphic model
Ann Emerg Med
Randomized clinical study of thiopentone loading in comatose survivors of cardiac arrest
N Engl J Med
Glucocorticoid treatment does not improve neurologic recovery following cardiac arrest
JAMA
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Therapeutic Hypothermia Following Cardiac Arrest After the TTM2 trial – More Questions Raised Than Answered
2023, Current Problems in CardiologyTargeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes
2019, IJC Heart and VasculatureCitation Excerpt :Another three studies were conducted in the same population so one was chosen for the analysis and the other two studies were excluded [7–9]. Nine randomized controlled trials were included in the meta-analysis utilizing data for in-hospital and out-of-hospital cardiac arrest patients [9,12–18]. Two reviewers (MA and AM) independently extracted the data for meta-analysis, and discrepancies were resolved by third reviewer (WM) and by consensus.
An experimental study and finite element modeling of head and neck cooling for brain hypothermia
2018, Journal of Thermal BiologyContemporary targeted temperature management: Clinical evidence and controversies
2023, Perfusion (United Kingdom)Temperature Control in the Era of Personalized Medicine: Knowledge Gaps, Research Priorities, and Future Directions
2023, Journal of Intensive Care MedicinePost-Cardiac Arrest: Mechanisms, Management, and Future Perspectives
2023, Journal of Clinical Medicine
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From the Department of Intensive Care, Dandenong Hospital,* and the Department of Neurosciences, Monash Medical Centre, Southern Health Care Network,‡ Victoria, Australia.
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Reprint no.47/1/83243
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Address for reprints: Dr Stephen Bernard, The Intensive Care Unit, Dandenong Hospital, David St, Dandenong, Victoria, Australia 3175, 61-3-9791-6000, Fax 61-3-9797-8378