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Hypothermia and neurological outcome after cardiac arrest: state of the art

Published online by Cambridge University Press:  01 February 2008

K. H. Polderman
K. H. Polderman*
Affiliation:
University Medical Center Utrecht, Department of Intensive Care, Utrecht, The Netherlands
*
Correspondence to: Kees H. Polderman, Department of Intensive Care, Q. D4.460, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands. E-mail: k.polderman@umcutrect.nl; Tel: +31 302504385; Fax: +31 655157833
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Summary

Multi-centred studies in patients who remain comatose after cardiac arrest and also in newborn babies with perinatal asphyxia have clearly demonstrated that mild hypothermia (32–34°C) can improve neurological outcome after post-anoxic injury. This represents a highly promising development in the field of neurocritical care. This review discusses the place of mild therapeutic hypothermia in the overall therapeutic strategy for cardiac arrest patients. Cooling should not be viewed in isolation but in the context of a ‘treatment bundle,’ which together can significantly improve outcome after cardiac arrest. Favourable outcomes of 50–60% are now routinely achieved in many centres in patients with witnessed arrest and an initial rhythm of ventricular fibrillation or ventricular tachycardia. These results have been achieved by combining a number of therapeutic strategies, including early and effective resuscitation with greater emphasis on continuing chest compressions throughout various procedures (including resumption of compressions immediately after defibrillation even if rhythm has been restored) as well as prevention of hypoxia and hypotension in all stages following restoration of spontaneous circulation. Regarding the use of hypothermia, early induction and proper management of side-effects are the key elements of successful implementation. Treatment should include the rapid infusion of 1500–3000 mL of cold fluids to induce hypothermia and prevent hypovolaemia and hypotension. Educational activities to increase awareness and acceptance of new therapeutic options and European Resuscitation Council guidelines are urgently required.

Keywords

CARDIAC ARRESTHYPOTHERMIAOUTCOMECRITICAL CARE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue S42 , February 2008 , pp. 23 - 30
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Benson, DW, Williams, GR, Spencer, FC. The use of hypothermia after cardiac arrest. Anesth Analg 1958; 38: 423–428.Google Scholar
2.JrWilliams, GR, Spencer, FC. The clinical use of hypothermia following cardiac arrest. Ann Surg 1958; 148: 462–468.CrossRefGoogle ScholarPubMed
3.Bernard, SA, Jones, BM, Horne, MK. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med 1997; 30: 146–153.CrossRefGoogle ScholarPubMed
4.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.Google ScholarPubMed
5.Zeiner, A, Holzer, M, Sterz, F et al. . Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Stroke 2000; 31: 86–94.CrossRefGoogle ScholarPubMed
6.Mori, K, Takeyama, Y, Itoh, Y et al. . A multivariate analysis of prognostic factors in survivors of out-of-hospital cardiac arrest with brain hypothermia therapy (abstract). Crit Care Med 2000; 28: A168.Google Scholar
7.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
8.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
9.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.CrossRefGoogle ScholarPubMed
10.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.CrossRefGoogle ScholarPubMed
11.The 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.CrossRefGoogle Scholar
12.Polderman, KH, Sterz, F, van Zanten, ARH et al. . Induced hypothermia improves neurological outcome in asystolic patients with out-of hospital cardiac arrest. Circulation 2003; 108: IV–581.Google Scholar
13.Rosamond, W, Flegal, K, Friday, G et al. . American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; 115: 69–171.CrossRefGoogle ScholarPubMed
14.Nolan, JP, Deakin, CD, Soar, J, Bottiger, BW, Smith, G, European Resuscitation Counc il. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 2005; 67 (Suppl 1): S39–S86.CrossRefGoogle ScholarPubMed
15.Holzer, M, Bernard, SA, Hachimi-Idrissi, S, Roine, RO, Sterz, F, Mullner, M. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. On behalf of the Collaborative Group on Induced Hypothermia for Neuroprotection After Cardiac Arrest. Crit Care Med 2005; 33: 414–418.CrossRefGoogle Scholar
16.Polderman, KH. Therapeutic hypothermia in the Intensive Care unit: problems, pitfalls and opportunities (review). Part 1: indications and evidence. Intensive Care Med 2004; 30: 556–575.CrossRefGoogle Scholar
17.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.CrossRefGoogle ScholarPubMed
18.Van Zanten, ARH, Polderman, KH. Early induction of hypothermia: will sooner be better? (Editorial). Critical Care Med 2005; 33: 1449–1452.Google Scholar
19.Eicher, DJ, Wagner, CL, Katikaneni, LP et al. . Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005; 32: 11–17.CrossRefGoogle ScholarPubMed
20.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.CrossRefGoogle ScholarPubMed
21.Shankaran, S, Laptook, AR, Ehrenkranz, RA et al. . Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353: 1574–1584.CrossRefGoogle ScholarPubMed
22.Polderman, KH, Peerdeman, SM, Girbes, AR. Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001; 94: 697–705.CrossRefGoogle ScholarPubMed
23.Polderman, KH. Induced hypothermia for neuroprotection: understanding the underlying mechanisms. In: 2006 Yearbook of Intensive Care and Emergency Medicine. New York: Springer, 2006: 337–351.Google Scholar
24.Nolan, JP, Deakin, CD, Soar, J, Bottiger, BW, Smith, G, European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 2005; 67 (Suppl 1): S39–S86.CrossRefGoogle ScholarPubMed
25.Hess, EP, White, RD. Ventricular fibrillation is not provoked by chest compression during post-shock organized rhythms in out-of-hospital cardiac arrest. Resuscitation 2005; 66: 7–11.CrossRefGoogle Scholar
26.Rea, TD, Shah, S, Kudenchuk, PJ, Copass, MK, Cobb, LA. Automated external defibrillators: to what extent does the algorithm delay CPR? Ann Emerg Med 2005; 46: 132–141.CrossRefGoogle ScholarPubMed
27.van Alem, AP, Sanou, BT, Koster, RW. Interruption of cardiopulmonary resuscitation with the use of the automated external defibrillator in out-of-hospital cardiac arrest. Ann Emerg Med 2003; 42: 449–457.CrossRefGoogle ScholarPubMed
28.Yannopoulos, D, Aufderheide, TP, Gabrielli, A et al. . Clinical and hemodynamic comparison of 15 : 2 and 30 : 2 compression-to-ventilation ratios for cardiopulmonary resuscitation. Crit Care Med 2006; 34: 1444–1449.CrossRefGoogle ScholarPubMed
29.Wik, L, Hansen, TB, Fylling, F et al. . Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. JAMA 2003; 289: 1389–1395.CrossRefGoogle ScholarPubMed
30.Rea, TD, Helbock, M, Perry, S et al. . Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest: survival implications of guideline changes. Circulation 2006; 114: 2760–2765.CrossRefGoogle ScholarPubMed
31.Abella, BS, Alvarado, JP, Myklebust, H et al. . Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005; 293: 305–310.CrossRefGoogle ScholarPubMed
32.Wik, L, Kramer-Johansen, J, Myklebust, H et al. . Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005; 293: 299–304.CrossRefGoogle ScholarPubMed
33.Valenzuela, TD, Kern, KB, Clark, LL et al. . Interruptions of chest compressions during emergency medical systems resuscitation. Circulation 2005; 112: 1259–1265.CrossRefGoogle Scholar
34.Abella, BS, Rhee, JW, Huang, KN, Vanden Hoek, TL, Becker, LB. Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey. Resuscitation 2005; 64: 181–186.CrossRefGoogle ScholarPubMed
35.Merchant, RM, Soar, J, Skrifvars, MB et al. . Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 2006; 34: 1935–1940.CrossRefGoogle ScholarPubMed
36.Boerrigter, MG, Girbes, ARJ, Polderman, KH. European survey on the use of induced hypothermia in ICU’s in Europe. Intensive Care Med 2006; 32: vS7(Abstract 9).Google Scholar
37.Oddo, M, Schaller, MD, Feihl, F, Ribordy, V, Liaudet, L. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med 2006; 34: 1865–1873.CrossRefGoogle ScholarPubMed
38.Busch, M, Soreide, E, Lossius, HM, Lexow, K, Dickstein, K. Rapid implementation of therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors. Acta Anaesthesiol Scand 2006; 50: 1277–1283.CrossRefGoogle ScholarPubMed
39.Kette, F, Pordenone Cardiac Arrest Cooperative Study Group (PACS). Increased survival despite a reduction in out-of-hospital ventricular fibrillation in north-east Italy. Resuscitation 2007; 72: 52–58.CrossRefGoogle ScholarPubMed
40.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.CrossRefGoogle ScholarPubMed
41.Polderman, KH, Rijnsburger, ER, Peerdeman, SM, Girbes, AR. Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med 2005; 33: 2744–2751.CrossRefGoogle ScholarPubMed
42.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 ScholarPubMed
43.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
44.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
45.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.CrossRefGoogle ScholarPubMed