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Overcooling during mild hypothermia in cardiac arrest survivors - phenomenon we should keep in mind


Authors: R. Škulec 1,2;  T. Kovárník 2;  prof. MUDr. Jan Bělohlávek, Ph.D. 2;  G. Dostálová 2;  J. Kolář 2;  A. Linhart 2;  J. Šeblová 1
Authors‘ workplace: Záchranná služba Středočeského kraje Kladno, ředitel MUDr. Robert Zelenák 1;  II. interní klinika kardiologie a angiologie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Aleš Linhart, DrSc. 2
Published in: Vnitř Lék 2008; 54(6): 609-614
Category: Original Contributions

Overview

Background:
Mild hypothermia (MH) in cardiac arrest survivors has became a routine part of early postresuscitative support. Overcooling is a frequent phenomenon with the unknown outcome.

Aim of the study:
To analyze the incidence and outcome of overcooling below body core temperature (BT) of 32 °C.

Material and methods:
We performed retrospective analysis of all 56 consecutive cardiac arrest survivors treated by MH who reached therapeutic BT in the IInd Department of Internal Medicine, General Teaching Hospital, Prague. MH was initiated as soon as possible after the return of spontaneous circulation to reach BT of 33 °C followed by maintainance of BT 32–34 °C for 12 hours. Patients were cooled by surface cooling via ice-packs and by interavenous infusion of cold crystaloids.

Results:
Overcooling below BT of 32 °C was observed in 23 patients (41%). This group of patients had more frequently asystole as the initial rhythm (34.8 vs 9.1%), more frequently were cooled by combinatory cooling approach (56.5 vs 27.3%), more frequently had lower baseline BT (35.3 ± 1.3 vs 36.2 ± 1.2 °C), higher cooling rate (the interval required for a decrease of BT by 1 °C 61.5 ± 53.1 vs 90.1 ± 50.0 min) (all p < 0.05) than patients with proper profile of BT during MH. Overcooling was independent negative predictor of discharge favourable neurological outcome (OR 0.16, 0.022-0.77, p = 0.037).

Conclusion:
Induction of MH by conventional cooling approach is burdened by high risk of overcooling. This phenomenon is probably associated with worse outcome.

Key words:
cardiac arrest - mild hypothermia - overcooling


Sources

1. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7.5: Postresuscitation Support. Circulation 2005; 112(Suppl 1): IV-84-IV-88.

2. Bernard SA, Gray TW, Buist MD et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346: 557-563.

3. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549-556.

4. Merchant RM, Abella BS, Peberdy MA et al. Therapeutic hypothermia after cardiac arrest: unintentional overcooling is common using ice packs and conventional cooling blankets. Crit Care Med 2006; 34(Suppl 12): S490-S494.

5. Kliegel A, Janata A, Wandaller C et al. Cold infusions alone are effective for induction of therapeutic hypothermia but do not keep patients cool after cardiac arrest. Resuscitation 2007; 73: 46-53.

6. Hoedemaekers CW, Ezzahti M, Gerritsen A et al. Comparison of cooling methods to induce and maintain normo- and hypothermia in intensive care unit patients: a prospective intervention study. Crit Care 2007; 11: R91.

7. Pichon N, Amiel JB, François B et al. Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system. Crit Care 2007; 11: R71.

8. Van de Werf F, Ardissino D, Betriu A et al. The task force on the management of acute myocardial infarction of the European society of cardiology. Eur Heart J 2003; 24: 28-66.

9. Widimský P, Janoušek S, Vojáček J. Doporučení pro diagnostiku a léčbu akutního infarktu myokardu (Q-typ/s elevacemi ST/raménkovým blokem). Cor Vasa 2002; 44: K123-K143.

10. Nieminen MS, Bohm M, Cowie MR et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 384-416.

11. Babaev A, Frederick PD, Pasta DJ et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 2005; 294: 448-454.

12. Škulec R, Bělohlávek J, Dytrych V et al. Protokol pro použití terapeutické mírné hypotermie u nemocných po srdeční zástavě. Cor Vasa 2007; 49: 61-65.

13. Cummins RO, Chamberlain DA, Abramson NS et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991; 84: 960-975.

14. Knaus WA, Draper EA, Wagner DP et al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-829.

15. Stein PD, Hull RD, Raskob G. Risks for major bleeding from thrombolytic therapy in patients with acute pulmonary embolism. Consideration of noninvasive management. Ann Intern Med 1994; 121: 313-317.

16. Skulec R, Kovarnik T, Dostalova G et al. Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome. Acta Anaesthesiol Scand 2008; 52: 188-194.

17. Sunde K, Pytte M, Jacobsen D et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007; 73: 29-39.

18. Hovdenes J, Laake JH, Aaberge L et al. Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock. Acta Anaesthesiol Scand 2007; 51: 137-142.

19. Werling M, Thorén AB, Axelsson C et al. Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced. Resuscitation 2007; 73: 40-45.

20. Bell DD, Brindley PG, Forrest D et al. Management following resuscitation from cardiac arrest: recommendations from the 2003 Rocky Mountain Critical Care Conference. Can J Anesth 2005; 52: 309-322.

21. Wright WL, Geocadin RG. Postresuscitative intensive care: neuroprotective strategies after cardiac arrest. Semin Neurol 2006; 26: 396-402.

22. Polderman KH. Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality - Part 2: Practical aspects and side effects. Intensive Care Med 2004; 30: 757-769.

23. Wolfrum S, Radke PW, Pischon T et al. Mild therapeutic hypothermia after cardiac arrest - a nationwide survey on the implementation of the ILCOR guidelines in German intensive care units. Resuscitation 2007; 72: 207-213.

24. Skulec R, Dostalova G, Kovarnik T et al. Therapeutic hypothermia in cardiac arrest survivors: a survey of practice in the Czech Republic. Resuscitation 2008; v tisku.

25. Lefrant JY, Muller L, de La Coussaye JE et al. Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med 2003; 29: 414-418.

26. Flint AC, Hemphill JC, Bonovich DC. Therapeutic hypothermia after cardiac arrest: performance characteristics and safety of surface cooling with or without endovascular cooling. Neurocrit Care 2007; 7: 109-118.

27. Guluma KZ, Hemmen TM, Olsen SE et al. A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke: methodology. Acad Emerg Med 2006; 13: 820-827.

28. Zeiner A, Holzer M, Sterz F et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med 2001; 161: 2007-2012.

29. Hickey RW, Kochanek PM, Ferimer H et al. Hypothermia and hyperthermia in children after resuscitation from cardiac arrest. Pediatrics 2000; 106: 118-122.

30. Bota DP, Ferreira FL, Melot C et al. Body temperature alterations in the critically ill. Intensive Care Med 2004; 30: 811-816.

31. Albrecht RF, Wass C, Lanier WL et al. Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury. Mayo Clin Proc 1998; 73: 629-635.

32. Vincent JL, Bihari DJ, Suter PM et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995; 274: 639-644.

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