Volume responsivness and its predictability in cardiac arrest survivors treated by mild hypothermia (MH)
Authors:
Škulec Roman 1; Linhart Aleš 2
Authors‘ workplace:
Záchranná služba Středočeského kraje, stanoviště Beroun
1; II. interní klinika kardiologie a angiologie, Všeobecná fakultní nemocnice, Praha
2
Published in:
Anest. intenziv. Med., 19, 2008, č. 4, s. 190-196
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
To assess whether cardiac arrest survivors treated by MH with low cardiac index (CI) respond to volumexpansion. To assess whether respiratory variability of maximal aortic valve blood flow (ΔVmaxao) and velocity time integral of aortic valve blood flow (ΔVTIao) predict fluid responsiveness (increase of CI of >15%).
Design:
Prospective observational study.
Setting:
Emergency Medical Service, Cardiovascular Medicine Department, University Hospital.
Material and Method:
We investigated 10 consecutive cardiac arrest survivors treated by MH, with CI of < 2.5 l/min/m2. CI, ΔVmaxao and ΔVTIao were measured by transthoracic echocardiography after stabilization of body temperature in the range of 32–34 °C. This was followed by rapid administration of normal saline (8 ml/kg) and the second measurement.
Results:
Volumexpansion was followed by CI increase in 8 patients (from 1.86 ± 0.36 to 2.69 ± 0.53 l/min/m2, p = 0,003, responders) while in 2 subjects was not (non-responders). The values of ΔVmaxao (25.6 ± 4.8 vs. 4.2 ± 3.4 %, p < 0.001) and ΔVTIao (35.6 ± 4.3 vs. 4.1 ± 0.8%, p < 0,001) before volumexpansion were higher in responders than in non-responders. In responders, it decreased after volumexpansion (ΔVmaxao: to 6.9 ± 3.6%, ΔVTIao: to 7.0 ± 3.5%, p < 0,001) while in non-responders not. The baseline values of ΔVmaxao (r = 0.588, p = 0.003) and ΔVTIao (r = 0.552, p = 0.003) correlated with further increase of CI.
Conclusion:
Majority of MH treated cardiac arrest survivors with low CI in our set responded to volumexpansion. High values of ΔVmaxao and ΔΔVTIao predicted fluid responsiveness, low values fluid unresponsiveness.
Key words:
cardiac arrests, mild hypothermia, fluid responsiveness
Sources
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Anaesthesiology and Intensive Care Medicine
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