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Devices for rapid induction of hypothermia

Published online by Cambridge University Press:  01 February 2008

M. Holzer
M. Holzer*
Affiliation:
Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
*
Correspondence to: Michael Holzer, Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, A-1090 Vienna, Austria. E-mail: michael.holzer@meduniwien.ac.at; Tel: +43 1 40400 1964; Fax: +43 1 40400 1965; Mobile: +43 664 2632869
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Summary

In industrial countries it is estimated that the incidence of out-of-hospital sudden cardiac arrest lies between 36 and 128 per 100 000 inhabitants per year. Almost 80% of patients who initially survive a cardiac arrest present with coma lasting more than 1 h. Current therapy during cardiac arrest concentrates on the external support of circulation and respiration with additional drug and electrical therapy. Therapeutic hypothermia provides a new and very effective therapy for neuroprotection in patients after cardiac arrest. It is critical that mild hypothermia has to be applied very early after the ischaemic insult to be effective, otherwise the beneficial effects would be diminished or even abrogated. There are numerous methods available for cooling patients after ischaemic states. Surface cooling devices are non-invasive and range from simple ice packs to sophisticated machines with automatic feedback control. Other non-invasive methods include drugs and cold liquid ventilation. The newer devices have cooling rates comparable to invasive catheter techniques. Invasive cooling methods include the administration of ice-cold fluids intravenously, the use of intravascular cooling catheters, body cavity lavage, extra-corporeal circuits and selective brain cooling. Most of these methods are quite invasive and are still in an experimental stage. The optimal timing and technique for the induction of hypothermia after cardiac arrest have not yet been defined, and it is currently a major topic of ongoing research. The induction of hypothermia after cardiac arrest needs to be an integral component of the initial evaluation and stabilization of the patient.

Keywords

CARDIAC ARRESTHYPOTHERMIAEQUIPMENT AND SUPPLIESOUTCOME
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue S42 , February 2008 , pp. 31 - 38
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Vreede-Swagemakers, JJ, Gorgels, AP, Dubois-Arbouw, WI et al. . Out-of-hospital cardiac arrest in the 990’s: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol 1997; 30: 1500–1505.CrossRefGoogle Scholar
2.European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Resuscitation 2005; 67: S1–S189.Google Scholar
3.Negovsky, VA. Postresuscitation disease. Crit Care Med 1988; 16: 942–946.CrossRefGoogle ScholarPubMed
4.Colbourne, F, Corbett, D. Delayed postischemic hypothermia: a six month survival study using behavioral and histological assessments of neuroprotection. J Neurosci 1995; 15: 7250–7260.CrossRefGoogle ScholarPubMed
5.Kuboyama, K, Safar, P, Radovsky, A, Tisherman, SA, Stezoski, SW, Alexander, H. Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study. Crit Care Med 1993; 21: 1348–1358.Google Scholar
6.Busto, R, Globus, MY, Dietrich, WD, Martinez, E, Valdes, I, Ginsberg, MD. Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 1989; 20: 904–910.CrossRefGoogle ScholarPubMed
7.Sterz, F, Leonov, Y, Safar, P et al. . Multifocal cerebral blood flow by Xe-CT and global cerebral metabolism after prolonged cardiac arrest in dogs. Reperfusion with open-chest CPR or cardiopulmonary bypass. Resuscitation 1992; 24: 27–47.Google Scholar
8.Oku, K, Kuboyama, K, Safar, P et al. . Cerebral and systemic arteriovenous oxygen monitoring after cardiac arrest. Inadequate cerebral oxygen delivery. Resuscitation 1994; 27: 141–152.Google Scholar
9.Oku, K, Sterz, F, Safar, P et al. . Mild hypothermia after cardiac arrest in dogs does not affect postarrest multifocal cerebral hypoperfusion. Stroke 1993; 24: 1590–1597.CrossRefGoogle Scholar
10.Lei, B, Tan, X, Cai, H, Xu, Q, Guo, Q. Effect of moderate hypothermia on lipid peroxidation in canine brain tissue after cardiac arrest and resuscitation. Stroke 1994; 25: 147–152.Google Scholar
11.Clark, RS, Kochanek, PM, Marion, DW et al. . Mild posttraumatic hypothermia reduces mortality after severe controlled cortical impact in rats. J Cereb Blood Flow Metab 1996; 16: 253–261.CrossRefGoogle ScholarPubMed
12.Chopp, M, Knight, R, Tidwell, CD, Helpern, JA, Brown, E, Welch, KM. The metabolic effects of mild hypothermia on global cerebral ischemia and recirculation in the cat: comparison to normothermia and hyperthermia. J Cereb Blood Flow Metab 1989; 9: 141–148.CrossRefGoogle ScholarPubMed
13.Bernard, S, Buist, M, Monteiro, O, Smith, K. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 2003; 56: 9–13.CrossRefGoogle ScholarPubMed
14.The Hypothermia After Cardiac Arrest (HACA) study group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549–556.Google Scholar
15.Yanagawa, Y, Ishihara, S, Norio, H et al. . Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest. Resuscitation 1998; 39: 61–66.CrossRefGoogle ScholarPubMed
16.Felberg, RA, Krieger, DW, Chuang, R et al. . Hypothermia after cardiac arrest: feasibility and safety of an external cooling protocol. Circulation 2001; 104: 1799–1804.CrossRefGoogle ScholarPubMed
17.Mayer, SA, Kowalski, RG, Presciutti, M et al. . Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med 2004; 32: 2508–2515.CrossRefGoogle ScholarPubMed
18.Plattner, O, Kurz, A, Sessler, DI et al. . Efficacy of intraoperative cooling methods. Anesthesiology 1997; 87: 1089–1095.Google Scholar
19.Janata, A, Weihs, W, Bayegan, K et al. . Thermosuit after prolonged cardiac arrest in pigs. Resuscitation 2006; 69: 145.Google Scholar
20.Wang, H, Olivero, W, Lanzino, G et al. . Rapid and selective cerebral hypothermia achieved using a cooling helmet. J Neurosurg 2004; 100: 272–277.Google Scholar
21.Hachimi-Idrissi, S, Corne, L, Ebinger, G, Michotte, Y, Huyghens, L. Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 2001; 51: 275–281.Google Scholar
22.Tooley, JR, Eagle, RC, Satas, S, Thoresen, M. Significant head cooling can be achieved while maintaining normothermia in the newborn piglet. Arch Dis Child Fetal Neonatal Ed 2005; 90: F262–F266.CrossRefGoogle ScholarPubMed
23.Gluckman, PD, Wyatt, JS, Azzopardi, D et al. . Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365: 663–670.Google Scholar
24.Bayegan, K, Janata, A, Weihs, W et al. . A new simple and non-invasive surface cooling method for rapid induction of mild hypothermia in adult human-sized pigs. Resuscitation 2006; 69: 91.Google Scholar
25.Uray, T, Sterz, F, Janata, A et al. . Surface cooling with a new cooling-blanket for rapid induction of mild hypothermia in humans after cardiac arrest: a feasibility trial. Resuscitation 2006; 69: 93.Google Scholar
26.Katz, LM, Young, A, Frank, JE, Wang, Y, Park, K. Neurotensin-induced hypothermia improves neurologic outcome after hypoxic-ischemia. Crit Care Med 2004; 32: 806–810.Google Scholar
27.Hong, SB, Koh, Y, Shim, TS et al. . Physiologic characteristics of cold perfluorocarbon-induced hypothermia during partial liquid ventilation in normal rabbits. Anesth Analg 2002; 94: 157–162.Google Scholar
28.Kliegel, A, Losert, H, Sterz, F et al. . Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest – a feasibility study. Resuscitation 2005; 64: 347–351.CrossRefGoogle ScholarPubMed
29.Kim, F, Olsufka, M, Carlbom, D et al. . Pilot study of rapid infusion of 2 L of 4 degrees C normal saline for induction of mild hypothermia in hospitalized, comatose survivors of out-of-hospital cardiac arrest. Circulation 2005; 112: 715–719.Google Scholar
30.Virkkunen, I, Yli-Hankala, A, Silfvast, T. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer’s solution: a pilot study. Resuscitation 2004; 62: 299–302.Google Scholar
31.Nordmark, J, Rubertsson, S. Induction of mild hypothermia with infusion of cold (4 degrees C) fluid during ongoing experimental CPR. Resuscitation 2005; 66: 357–365.CrossRefGoogle ScholarPubMed
32.Boddicker, KA, Zhang, Y, Zimmerman, MB, Davies, LR, Kerber, RE. Hypothermia improves defibrillation success and resuscitation outcomes from ventricular fibrillation. Circulation 2005; 111: 3195–3201.CrossRefGoogle ScholarPubMed
33.Vanden Hoek, TL, Kasza, KE, Beiser, DG, Abella, BS, Franklin, JE, Oras, JJ. Induced hypothermia by central venous infusion: saline ice slurry versus chilled saline. Crit Care Med 2004; 32: S425–S431.Google Scholar
34. Kliegel A, Janata A, Wandaller C et al. Keep Cool – cold infusions and muscle relaxation are sufficient for induction but not for maintenance of hypothermia after cardiac arrest. Resuscitation 2007; 73: 46–53.Google Scholar
35.Xiao, F, Safar, P, Alexander, H. Peritoneal cooling for mild cerebral hypothermia after cardiac arrest in dogs. Resuscitation 1995; 30: 51–59.Google Scholar
36.Diringer, MN. Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 2004; 32: 559–564.Google Scholar
37.Dixon, SR, Whitbourn, RJ, Dae, MW et al. . Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction. J Am Coll Cardiol 2002; 40: 1928–1934.CrossRefGoogle ScholarPubMed
38.Al Senani, FM, Graffagnino, C, Grotta, JC et al. . A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGard System and Icy catheter following cardiac arrest. Resuscitation 2004; 62: 143–150.CrossRefGoogle ScholarPubMed
39.Holzer, M, Mullner, M, Sterz, F et al. . Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach. Stroke 2006; 37: 1792–1797.CrossRefGoogle ScholarPubMed
40.Holzer, M, Behringer, W, Janata, A et al. . Extracorporeal venovenous cooling for induction of mild hypothermia in human-sized swine. Crit Care Med 2005; 33: 1346–1350.Google Scholar
41.Nagao, K, Hayashi, N, Kanmatsuse, K et al. . Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital. J Am Coll Cardiol 2000; 36: 776–783.CrossRefGoogle ScholarPubMed
42.Mori, K, Saito, J, Kurata, Y et al. . Rapid development of brain hypothermia using femoral-carotid bypass. Acad Emerg Med 2001; 8: 303–308.Google Scholar
43.Abella, BS, Zhao, D, Alvarado, J, Hamann, K, Vanden Hoek, TL, Becker, LB. Intra-arrest cooling improves outcomes in a murine cardiac arrest model. Circulation 2004; 109: 2786–2791.CrossRefGoogle Scholar
44.Dietrich, WD, Busto, R, Alonso, O, Globus, MY, Ginsberg, MD. Intraischemic but not postischemic brain hypothermia protects chronically following global forebrain ischemia in rats. J Cereb Blood Flow Metab 1993; 13: 541–549.CrossRefGoogle Scholar
45.Vanden Hoek, TL, Shao, Z, Li, C, Zak, R, Schumacker, PT, Becker, LB. Reperfusion injury on cardiac myocytes after simulated ischemia. Am J Physiol 1996; 270: H1334–H1341.Google ScholarPubMed
46.Vanden Hoek, TL, Qin, Y, Wojcik, K et al. . Reperfusion, not simulated ischemia, initiates intrinsic apoptosis injury in chick cardiomyocytes. Am J Physiol Heart Circ Physiol 2003; 284: H141–H150.CrossRefGoogle Scholar
47.Nozari, A, Safar, P, Stezoski, SW et al. . Mild hypothermia during prolonged cardiopulmonary cerebral resuscitation increases conscious survival in dogs. Crit Care Med 2004; 32: 2110–2116.Google Scholar
48.Behringer, W, Prueckner, S, Kentner, R et al. . Rapid hypothermic aortic flush can achieve survival without brain damage after 30 minutes cardiac arrest in dogs. Anesthesiology 2000; 93: 1491–1499.CrossRefGoogle ScholarPubMed
49.Janata, A, Holzer, M, Bayegan, K et al. . Aortic flush for rapid induction of cerebral hypothremia during normovolemic cardiac arrest in swine. Resuscitation 2004; 62: 342.Google Scholar