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Therapeutic hypothermia after cardiac arrest and myocardial infarction

https://doi.org/10.1016/j.bpa.2008.02.001Get rights and content

About 17 million people worldwide die from cardiovascular diseases each year. Impaired neurologic function after sudden cardiac arrest is a major cause of death in these patients. Up to now, no specific post-arrest therapy was available to improve outcome. Recently, two randomized clinical trials of mild therapeutic hypothermia after successful resuscitation from cardiac arrest showed improvement of neurological outcome and reduced mortality. A broad implementation of this new therapy could save thousands of lives worldwide, as only 6 patients have to be treated to get one additional patient with favourable neurological recovery.

At present, myocardial reperfusion by thrombolytic therapy or primary PCI as early as possible is the most effective therapy in patients with acute myocardial infarction. Mild therapeutic hypothermia might be a promising new therapy to prevent reperfusion injury after myocardial infarction, but its use in daily clinical routine cannot be recommended with the available evidence.

Section snippets

Epidemiology of cardiac arrest

The world leading cause of morbidity and death are cardiovascular diseases. About 17 million people worldwide die from these each year.1 Many of theses deaths are due to sudden cardiac arrest. The incidence of out-of-hospital sudden cardiac arrest lies between 36 and 128 per 100,000 inhabitants per year in industrial countries. Unfortunately, full cerebral recovery after cardiac arrest is still a rare event. Eighty percent of patients after cardiac arrest stay in coma lasting more than one

Non-randomized trials

The first case series of hypothermia after cardiac arrest was published in the late 1950ies.38 Since then, over 20 non-randomized trials of therapeutic hypothermia after cardiac arrest have been published.39, 40, 41, 42, 43, 44, *45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62 The target temperature that has been used in these trials was very consistently a range of 32–34 °C, the rate of patients with ventricular fibrillation was between 35–100%, the time from cardiac

Cooling methods

The optimal timing and technique for the induction of hypothermia after cardiac arrest is not yet defined, and it is currently a major topic of ongoing research. The therapeutic hypothermia therapy consists of three phases: induction, maintenance and rewarming. Extrapolated from animal studies20 the induction of hypothermia should be initiated as early as possible after cardiac arrest. Ideally the maintenance phase should be done with a regulated device such to avoid overshoot of cooling or

Therapeutic hypothermia after cardiac arrest

Induced hypothermia significantly improves outcomes in comatose survivors after resuscitation from out-of-hospital cardiac arrest. As stated in the resuscitation guidelines 2005 of the European Resuscitation Council5 all comatose survivors after ventricular fibrillation out-of-hospital cardiac arrest should be cooled as fast as possible to a temperature of 32–34 °C over 12 to 24 hours. This therapy might also be beneficial in patients with other rhythms or causes or in-hospital cardiac arrest.

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