Cooling after successful resuscitation in cardiac surgery patients

Journal of Cardiothoracic Surgery

Friedrich Wilhelm Mohr¹  Martin Kostelka¹  Farhad Bakhtiary¹  Martin Misfeld¹  Michael Hoebartner¹  Philipp Kiefer¹  Thilo Noack¹  Joerg Seeburger¹  Carlos Correia¹  Knut Roehrich¹  Marcel Vollroth¹ 

[1] Department of Cardiac Surgery, Heart Center Leipzig University, Struempellstrasse 39, 04289, Leipzig, Germany

关键词: Neurological outcome;    Therapeutic hypothermia;    Cardiac arrest;   

Others  :  824028
DOI  :  10.1186/1749-8090-8-190

 received in 2012-11-05, accepted in 2013-09-12,  发布年份 2013

【 摘 要 】

Background

Despite many years of intensive research sudden cardiac death is one of the most common causes of death all over the world. The European Resuscitation Council (ERC) recommends the use of moderate therapeutic hypothermia for 12–24 hours to improve neurological outcome. However, the beneficial effect of this therapy on outcomes for cardiac surgery patients with In- Hospital- Resuscitation (IHR) has not been well studied.

The purpose of this single center analysis was to investigate our first experience in a non – selected IHR population, where hypothermia was induced independent from initial heart rhythm disturbance.

Method

A total of 20 resuscitated patients who were treated in our institution between January 2010 and December 2011 formed the study cohort.

Results

In all patients post- resuscitation course was significantly prolonged with severe low cardiac output syndrome in six patients (30%). Overall four patients (20%) sustained septicemia with the need for high dose inotropic support. The 30 day mortality was 30% (six of twenty). However, stroke with severe neurological impairment appeared in only four patients (20%) after resuscitation with subsequent therapeutic hypothermia.

Conclusion

With our observation study we could demonstrate the benefits for neurological outcome due to therapeutic hypothermia in cardiac surgery patients after successful resuscitation. However post- resuscitation treatment should focus on sufficient therapeutic strategies to avoid the distinctive short term morbidity and mortality.

【 授权许可】

   
2013 Vollroth et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Jamin C, Hamilton SE: Implementation of hypothermia after cardiac arrest in the intensive care unit. ICU Dir 2011, 2:97.
• [2]The hypothermia after cardiac arrest study group: Mild therapeutic hypothermia to improve the neurological outcome after cardiac arrest. N Engl J Med 2002, 346:549-556.
• [3]Lundbye JB, Rai M, Ramu B, Hosseini- Khalili A, Li D, Slim HB, Bhavnani SP, Nair SU, Kluger J: Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non- shockable rhythm. Resuscitation 2012, 83:202-207.
• [4]Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K, European RC: European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances. Resuscitation 2005, 67:135-170.
• [5]Safar P, Bircer N: Cardiopulmonary cerebral resuscitation: basic and advanced cardiac and trauma life support: an introduction to resuscitation medicine. 3rd edition. London: W.B. Saunders; 1988.
• [6]Arrich J: Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 2007, 35:1041-1047.
• [7]Oddo M, Ribordy V, Feihl F, Rossetti AO, Schaller MD, Chioléro R, Liaudet L: Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study. Crit Care Med 2008, 36:2296-2301.
• [8]Cheung KW, Green RS, Magee KD: State of the art- systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients. Can J Emerg Med 2006, 8:329-333.