27 Jan 06
Posted in Cardiac arrest/Resuscitation, Critical Care at 9:01 by Laci
The 2005 AHA guideline for CPR and ECC are based on the most compherensive review of resuscitation literature ever published, according to the introduction outlining the major changes in the guidelines. The evidence evaluation process incorporated the inut of 281 international resuscitation experts who evaluated research, topics and hypotheses over a 36-month period.
The guidelines can act as a vital tool to increase the chanches of survival from cardiac arrest and life-threatening emergencies.
The guideline were published in the Supplement to Circulation 2005. All articles are available online at: http://circ.ahajournals.org/content/vol112/24_suppl/
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13 Jan 06
Posted in Cardiac arrest/Resuscitation, Critical Care, Hypothermia at 14:00 by Laci
By S Bernard, T Gray, M Buist, B Jones, et al.
N Engl J Med 2002;346:557-63.
Background
Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out– of-hospital cardiac arrest.
Methods
The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33 deg C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility.
Results
The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome – that is, they were discharged home or to a rehabilitation facility – as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events.
Conclusions
Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest.
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Posted in Cardiac arrest/Resuscitation, Critical Care, Hypothermia at 13:58 by Laci
By The Hypothermia After Cardiac Arrest Group
N Engl J Med 2002;346:549-56
Background
Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation.
Methods
In this multicenter trial with blinded assessment of the outcome, patients who had been resuscitated after cardiac arrest due to ventricular fibrillation were randomly assigned to undergo therapeutic hypothermia (target temperature, 32 deg C to 34 deg C, measured in the bladder) over a period of 24 hours or to receive standard treatment with normothermia. The primary end point was a favorable neurologic outcome within six months after cardiac arrest; secondary end points were mortality within six months and the rate of complications within seven days.
Results
Seventy-five of the 136 patients in the hypothermia group for whom data were available (55 percent) had a favorable neurologic outcome (cerebral– performance category, 1 [good recovery] or 2 [moderate disability]), as compared with 54 of 137 (39 percent) in the normothermia group (risk ratio, 1.40; 95 percent confidence interval, 1.08 to 1.81). Mortality at six months was 41 percent in the hypothermia group (56 of 137 patients died), as compared with 55 percent in the normothermia group (76 of 138 patients; risk ratio, 0.74; 95 percent confidence interval, 0.58 to 0.95). The complication rate did not differ significantly between the two groups.
Conclusions
In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.
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Posted in Cardiac arrest/Resuscitation, Critical Care, Hypothermia at 13:56 by Laci
Editorial by Gregory D Curfman
N Engl J Med 2002;346:546
For decades, cooling the body below the normal physiologic temperature has been used as a therapeutic tool. Hypothermia is used most often during cardiac surgery with cardiopulmonary bypass, as a means of protecting the brain from ischemic injury. Hypothermia is also used during some neurosurgical procedures and is being investigated as a treatment for ischemic stroke and traumatic brain injury. In this issue of the Journal, two groups of investigators report on the use of therapeutic hypothermia to prevent neurologic injury in comatose survivors of cardiac arrest.
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