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Aziz S, Clough M, Butterfield E, Starr Z, Lachowycz K, Price J, Barnard EB, Rees P. The association between prehospital post-return of spontaneous circulation core temperature and survival after out-of-hospital cardiac arrest. Eur J Emerg Med 2024; 31:356-362. [PMID: 38752563 PMCID: PMC11356685 DOI: 10.1097/mej.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/04/2024] [Indexed: 08/30/2024]
Abstract
BACKGROUND AND IMPORTANCE Following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA), a low body temperature on arrival at the hospital and on admission to the ICU is reportedly associated with increased mortality. Whether this association exists in the prehospital setting, however, is unknown. OBJECTIVE The objective of this study was to investigate whether the initial, prehospital core temperature measured post-ROSC is independently associated with survival to hospital discharge in adult patients following OHCA. DESIGN, SETTING AND PARTICIPANTS This retrospective observational study was conducted at East Anglian Air Ambulance, a physician-paramedic staffed Helicopter Emergency Medical Service in the East of England, UK. Adult OHCA patients attended by East Anglian Air Ambulance from 1 February 2015 to 30 June 2023, who had post-ROSC oesophageal temperature measurements were included. OUTCOME MEASURE AND ANALYSIS The primary outcome measure was survival to hospital discharge. Core temperature was defined as the first oesophageal temperature recorded following ROSC. Multivariable logistic regression evaluated the adjusted association between core temperature and survival to hospital discharge. MAIN RESULTS Resuscitation was attempted in 3990 OHCA patients during the study period, of which 552 patients were included in the final analysis. The mean age was 61 years, and 402 (72.8%) patients were male. Among them, 194 (35.1%) survived to hospital discharge. The mean core temperature was lower in nonsurvivors compared with those who survived hospital discharge; 34.6 and 35.2 °C, respectively (mean difference, -0.66; 95% CI, -0.87 to -0.44; P < 0.001). The adjusted odds ratio for survival was 1.41 (95% CI, 1.09-1.83; P = 0.01) for every 1.0 °C increase in core temperature between 32.5 and 36.9 °C. CONCLUSION In adult patients with ROSC following OHCA, early prehospital core temperature is independently associated with survival to hospital discharge.
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Affiliation(s)
- Shadman Aziz
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - Molly Clough
- Newcastle University School of Medicine, Newcastle University, Newcastle upon Tyne
| | - Emma Butterfield
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - Zachary Starr
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - Kate Lachowycz
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
| | - James Price
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Ed B.G. Barnard
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham
| | - Paul Rees
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich
- Barts Interventional Group, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
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Li A, Hegazy AF, Vasquez LEM, Liu L, Durocher AM, Vucetic A, Patel A, Fleming C, Chui J. Characterizing the impact of thermoregulation in patients after cardiac arrest: a retrospective cohort study. Can J Anaesth 2024; 71:629-639. [PMID: 38514524 DOI: 10.1007/s12630-024-02737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/30/2023] [Accepted: 11/11/2023] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Core body temperature has been extensively investigated as a thereuptic target in care after cardiac arrest. Nevertheless, the integrity of thermoregulation in patients after cardiac arrest has not been well studied. We sought to evaluate whether low spontaneous body temperature after cardiac arrest is associated with increased death and a worse neurologic outcome, and whether patients with low spontaneous body temperature exhibit features suggestive of impaired thermoregulation. METHODS We conducted a single-centre retrospective cohort study. We included all adult patients who underwent temperature control with hypothermia after cardiac arrest between 1 January 2014 and 30 June 2020. The primary exposure was low spontaneous core body temperature (< 35 °C) at initiation of hypothermia therapy. The primary outcome was in-hospital death and the secondary outcome was poor neurologic outcomes at discharge. RESULTS Five hundred and ninety-seven adult patients, comprising both in- and out-of-hospital cardiac arrests, were included. Patients with low spontaneous body temperature also had slightly lower average temperature, and more frequent transient but controlled breakthrough fever episodes in the first 24 hr. In the multivariable logistic regression analysis, low spontaneous body temperature was associated with higher odds of in-hospital death (odds ratio, 2.9; 95% confidence interval, 1.9 to 4.2; P < 0.001). CONCLUSION In this single-centre retrospective cohort study, low spontaneous core body temperature was associated with poor outcomes in patients after cardiac arrest. Patients with low spontaneous body temperature also exhibited features suggestive of impaired thermoregulation. Further research is needed to determine whether body temperature upon presentation reflects the robustness of the patient's underlying physiology and severity of brain insult after a cardiac arrest.
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Affiliation(s)
- Annie Li
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
| | - Ahmed F Hegazy
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
- Department of Critical Care, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
| | - Luis E Mendoza Vasquez
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
| | - Lisa Liu
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandra M Durocher
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
| | - Andrea Vucetic
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
| | - Arjun Patel
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
| | - Courtney Fleming
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada
| | - Jason Chui
- Department of Anesthesia & Perioperative Medicine, Schulich School Medicine & Dentistry, Western University, London, ON, Canada.
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, C3-106, University Hospital, 339 Windermere Rd., London, ON, N6A 5A5, Canada.
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Kadden M, Zhang A, Shoykhet M. Association of temperature management strategy with fever in critically ill children after out-of-hospital cardiac arrest. Front Pediatr 2024; 12:1355385. [PMID: 38659696 PMCID: PMC11039828 DOI: 10.3389/fped.2024.1355385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Objective To determine whether ICU temperature management strategy is associated with fever in children with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). Methods We conducted a single-center retrospective cohort study at a quaternary Children's hospital between 1/1/2016-31/12/2020. Mechanically ventilated children (<18 y/o) admitted to Pediatric or Cardiac ICU (PICU/CICU) with ROSC after OHCA who survived at least 72 h were included. Primary exposure was initial PICU/CICU temperature management strategy of: (1) passive management; or (2) warming with an air-warming blanket; or (3) targeted temperature management with a heating/cooling (homeothermic) blanket. Primary outcome was fever (≥38°C) within 72 h of admission. Results Over the study period, 111 children with ROSC after OHCA were admitted to PICU/CICU, received mechanical ventilation and survived at least 72 h. Median age was 31 (IQR 6-135) months, 64% (71/111) were male, and 49% (54/111) were previously healthy. Fever within 72 h of admission occurred in 51% (57/111) of patients. The choice of initial temperature management strategy was associated with occurrence of fever (χ2 = 9.36, df = 2, p = 0.009). Fever occurred in 60% (43/72) of patients managed passively, 45% (13/29) of patients managed with the air-warming blanket and 10% (1/10) of patients managed with the homeothermic blanket. Compared to passive management, use of homeothermic, but not of air-warming, blanket reduced fever risk [homeothermic: Risk Ratio (RR) = 0.17, 95%CI 0.03-0.69; air-warming: RR = 0.75, 95%CI 0.46-1.12]. To prevent fever in one child using a homeothermic blanket, number needed to treat (NNT) = 2. Conclusion In critically ill children with ROSC after OHCA, ICU temperature management strategy is associated with fever. Use of a heating/cooling blanket with homeothermic feedback reduces fever incidence during post-arrest care.
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Affiliation(s)
- Micah Kadden
- Pediatric Critical Care Medicine, Children’s National Hospital, Washington, DC,United States
- Pediatric Critical Care Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
| | - Anqing Zhang
- Division of Biostatistics and Study Methodology, Children’s National Hospital, Silver Spring, MD, United States
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC,United States
| | - Michael Shoykhet
- Pediatric Critical Care Medicine, Children’s National Hospital, Washington, DC,United States
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC,United States
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Prehospital body temperature measurement in trauma patients: A literature review. Injury 2022; 53:1737-1745. [PMID: 35431040 DOI: 10.1016/j.injury.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Accidental hypothermia in trauma patients can contribute to cardiorespiratory dysfunction, acidosis, and coagulopathy, causing increased morbidity and mortality. The early recognition of the clinical signs of hypothermia and the accurate measurement of body temperature by prehospital care providers are essential to avoid deterioration. This review provides an overview of studies that examine the reliability of different core temperature measurement options, with a focus on the prehospital setting. METHODS A search was performed in PubMed, Embase, Cochrane Library, and CINAHL using combinations of the Medical Subject Headings terms "ambulances," "emergency medical services," "thermometers," "body temperature," "hypothermia," and "body temperature regulation." Studies up to October 2021 were included, and different measurement options were listed and discussed. Eligible studies included those that identified the specific type of thermometer and focused on the out-of-hospital environment. RESULTS The search strategy yielded 521 studies, five of which met the eligibility criteria. Four studies focused on tympanic temperature measurement, and one focused on temporal artery temperature measurement. Among the noninvasive options, tympanic temperature measurement was most frequently identified as a reliable option for out-of-hospital use. CONCLUSION A thermistor-based tympanic thermometer that features insulation of the ear and a temperature probe with a cap is likely the most suitable option for prehospital body temperature measurement in trauma patients. These results are based on outdated literature with currently more novel temperature measurement devices available. Future studies are necessary to provide strong recommendations regarding temperature measurement due to emerging technology, the lack of studies, and the heterogeneity of existing studies.
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Yoshimura S, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Yagi Y, Kishimoto M, Kim SH, Hayashi Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Nakamura F, Matsuyama T, Okada Y, Nishioka N, Matsui S, Kimata S, Kawai S, Makino Y, Kitamura T, Iwami T. Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan). BMC Emerg Med 2022; 22:84. [PMID: 35568800 PMCID: PMC9107729 DOI: 10.1186/s12873-022-00641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background The association between spontaneous initial body temperature on hospital arrival and neurological outcomes has not been sufficiently studied in patients after out-of-hospital cardiac arrest (OHCA). Methods From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all patients with OHCA of medical origin aged > 18 years for whom resuscitation was attempted and who were transported to participating hospitals between 2012 and 2019. We excluded patients who were not witnessed by bystanders and treated by a doctor car or helicopter, which is a car/helicopter with a physician. The patients were categorized into three groups according to their temperature on hospital arrival: ≤35.9 °C, 36.0–36.9 °C (normothermia), and ≥ 37.0 °C. The primary outcome was 1-month survival, with a cerebral performance category of 1 or 2. Multivariable logistic regression analyses were performed to evaluate the association between temperature and outcomes (normothermia was used as the reference). We also assessed this association using cubic spline regression analysis. Results Of the 18,379 patients in our database, 5014 witnessed adult OHCA patients of medical origin from 16 hospitals were included. When analyzing 3318 patients, OHCA patients with an initial body temperature of ≥37.0 °C upon hospital arrival were associated with decreased favorable neurological outcomes (6.6% [19/286] odds ratio, 0.51; 95% confidence interval, 0.27–0.95) compared to patients with normothermia (16.4% [180/1100]), whereas those with an initial body temperature of ≤35.9 °C were not associated with decreased favorable neurological outcomes (11.1% [214/1932]; odds ratio, 0.78; 95% confidence interval, 0.56–1.07). The cubic regression splines demonstrated that a higher body temperature on arrival was associated with decreased favorable neurological outcomes, and a lower body temperature was not associated with decreased favorable neurological outcomes. Conclusions In adult patients with OHCA of medical origin, a higher body temperature on arrival was associated with decreased favorable neurologic outcomes.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-, Sayama, Japan
| | - Yoshiki Yagi
- Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-, Osaka, Japan
| | - Sung-Ho Kim
- Senshu Trauma and Critical Care Center, Osaka, Japan
| | - Yasuyuki Hayashi
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Haruko Sakamoto
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan
| | - Keitaro Suzuki
- Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Shunsuke Kawai
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Yuto Makino
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan, Postal code: 606-8501, YoshidaHonmachi, Sakyo, Kyoto, Japan.
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Kaylor HL, Wiencek C, Hundt E. Targeted Temperature Management: A Program Evaluation. AACN Adv Crit Care 2022; 33:38-52. [PMID: 35259224 DOI: 10.4037/aacnacc2022398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In the United States, more than 350 000 cardiac arrests occur annually. The survival rate after an out-of-hospital cardiac arrest remains low. The majority of patients who have return of spontaneous circulation will die of complications of hypoxic-ischemic brain injury. Targeted temperature management is the only recommended neuroprotective measure for those who do not regain consciousness after return of spontaneous circulation. Despite current practices, a review of the literature revealed that evidence on the ideal time to achieve target temperature after return of spontaneous circulation remains equivocal. A program evaluation of a targeted temperature management program at an academic center was performed; the focus was on timing components of targeted temperature management. The program evaluation revealed that nurse-driven, evidence-based protocols can lead to optimal patient outcomes in this low-frequency, high-impact therapy.
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Affiliation(s)
- Hannah L Kaylor
- Hannah L. Kaylor is CICU APP Fellow, Emory Healthcare, Division of Cardiology, 1364 Clifton Rd NE, Atlanta, GA 30322
| | - Clareen Wiencek
- Clareen Wiencek is Professor of Nursing, School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Elizabeth Hundt
- Elizabeth Hundt is Assistant Professor of Nursing, School of Nursing, University of Virginia, Charlottesville, Virginia
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Thermal Index for early non-invasive assessment of brain injury in newborns treated with therapeutic hypothermia: preliminary report. Sci Rep 2021; 11:12578. [PMID: 34131269 PMCID: PMC8206354 DOI: 10.1038/s41598-021-92139-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.
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Walas W, Bandoła D, Ostrowski Z, Rojczyk M, Mączko A, Halaba Z, Nowak AJ. Theoretical basis for the use of non-invasive thermal measurements to assess the brain injury in newborns undergoing therapeutic hypothermia. Sci Rep 2020; 10:22167. [PMID: 33335145 PMCID: PMC7747633 DOI: 10.1038/s41598-020-79009-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this paper is to propose a new non-invasive methodology to estimate thermogenesis in newborns with perinatal asphyxia (PA) undergoing therapeutic hypothermia (TH). Metabolic heat production (with respect to either a neonate’s body mass or its body surface) is calculated from the newborn’s heat balance, estimating all remaining terms of this heat balance utilising results of only non-invasive thermal measurements. The measurement devices work with standard equipment used for therapeutic hypothermia and are equipped with the Global System for Mobile Communications (GSM), which allows one to record and monitor the course of the therapy remotely (using an internet browser) without disturbing the medical personnel. This methodology allows one to estimate thermogenesis in newborns with perinatal asphyxia undergoing therapeutic hypothermia. It also offers information about instantaneous values of the rate of cooling together with values of remaining rates of heat transfer. It also shows the trend of any changes, which are recorded during treatment. Having information about all components of the heat balance one is able to facilitate comparison of results obtained for different patients, in whom these components may differ. The proposed method can be a new tool for measuring heat balance with the possibility of offering better predictions regarding short-term neurologic outcomes and tailored management in newborns treated by TH.
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Affiliation(s)
- Wojciech Walas
- Paediatric and Neonatal Intensive Care Unit, University Clinical Hospital, Opole, Poland.,Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Dominika Bandoła
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Ziemowit Ostrowski
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Marek Rojczyk
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Anna Mączko
- Paediatric and Neonatal Intensive Care Unit, University Clinical Hospital, Opole, Poland
| | - Zenon Halaba
- Department of Paediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Andrzej J Nowak
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland.
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Increased Heat Generation in Postcardiac Arrest Patients During Targeted Temperature Management Is Associated With Better Outcomes. Crit Care Med 2019; 46:1133-1138. [PMID: 29620555 DOI: 10.1097/ccm.0000000000003154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (Ttarget) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to Ttarget and outcomes. DESIGN Retrospective cohort study. SETTING Urban tertiary-care hospital. PATIENTS Successfully resuscitated targeted temperature management-treated adult postarrest patients between 2008 and 2015 with serial temperature data and Ttarget less than or equal to 34°C. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Time to Ttarget was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation ("heat units") was calculated as inverse of average water temperature × hours between initiation and Ttarget × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3-5 generated less heat before reaching Ttarget (median, 8.1 heat units [interquartile range, 3.6-21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.3 hr [interquartile range, 1.5-4.0 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01) than patients with Cerebral Performance Category score 1-2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6-20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.2 hr [interquartile range, 1.5-3.8 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01). Controlling for average water temperature between initiation and Ttarget, the relationship between outcomes and time to Ttarget was no longer significant. Controlling for location, witnessed arrest, age, initial rhythm, and neuromuscular blockade use, increased heat generation was associated with better neurologic (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.039) and survival (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.045) outcomes. CONCLUSIONS Increased heat generation during targeted temperature management initiation is associated with better outcomes at hospital discharge and may affect the relationship between time to Ttarget and outcomes.
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Chaseling GK, Allen DR, Vucic S, Barnett M, Frohman E, Davis SL, Jay O. Core temperature is not elevated at rest in people with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2019; 29:62-67. [PMID: 30684887 DOI: 10.1016/j.msard.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/28/2018] [Accepted: 01/02/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE To reassess the notion that people with multiple sclerosis (MS) do not demonstrate an elevated resting core temperature when measured using best-practice precision thermometry. METHOD Across two international data collection sites (Australia and USA), twenty-eight relapsing-remitting MS patients and 27 aged-matched controls (CON) were exposed to either 30 °C, 30% relative humidity (RH) (Sydney) or 25 °C, 30% RH (Dallas). Resting rectal (Tre) and esophageal (Teso) temperature and resting oxygen consumption (VO2) was measured in MS (n = 28) and CON (n = 27) groups who completed the 25 °C and 30 °C trials. Tympanic membrane (Ttym) temperature was measured in MS (n = 16) and CON (n = 15) groups in the 30 °C condition. A modified fatigue impact scale (MFIS) questionnaire was used to assess subjective measures of psychosocial, physical and cognitive fatigue in the 30 °C condition. RESULTS Irrespective of ambient temperature, no group differences were observed for Tre (MS: 37.07 ± 0.30 °C; CON: 37.18 ± 0.30 °C; P = 0.29), Teso (MS: 36.84 ± 0.42 °C; CON: 36.92 ± 0.29 °C; P = 0.36) or resting VO2 (MS: 3.89 ± 0.18 ml⋅kg-1⋅min-1; CON: 3.98 ± 0.17 ml⋅kg-1⋅min-1; P = 0.67). Similarly, no group differences were observed for Ttym (MS: 36.52 ± 0.38 °C; CON: 36.61 ± 0.33 °C; P = 0.55) in the 30 °C condition. Resting Tre did not correlate with subjective measures of fatigue: physical: r = -0.11, P = 0.67; cognitive: r = -0.14, P = 0.60; and psychosocial: r = 0.05, P = 0.84. CONCLUSION Contrary to recent reports, resting core temperature is not elevated in relapsing-remitting MS patients compared to healthy controls when measured using precision thermometry. Furthermore, no association was observed between resting Tre and any subjective measures of fatigue in a subset of participants with MS.
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Affiliation(s)
- Georgia K Chaseling
- The University of Sydney, Thermal Ergonomics Laboratory, Faculty of Health Sciences, Lidcombe NSW, Australia
| | - Dustin R Allen
- Applied Physiology & Wellness, Southern Methodist University, Dallas, TX, United States
| | - Steve Vucic
- Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Michael Barnett
- The University of Sydney, Brain and Mind Research Centre, Sydney Medical School, NSW, Australia
| | - Elliot Frohman
- Neurology and Neurotherapeutics, University of Texas Southwestern Medical Centre, Dallas, TX, United States
| | - Scott L Davis
- Applied Physiology & Wellness, Southern Methodist University, Dallas, TX, United States; Neurology and Neurotherapeutics, University of Texas Southwestern Medical Centre, Dallas, TX, United States
| | - Ollie Jay
- The University of Sydney, Thermal Ergonomics Laboratory, Faculty of Health Sciences, Lidcombe NSW, Australia; The University of Sydney, Charles Perkins Centre, Camperdown, NSW, Australia.
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Hovdenes J, Røysland K, Nielsen N, Kjaergaard J, Wanscher M, Hassager C, Wetterslev J, Cronberg T, Erlinge D, Friberg H, Gasche Y, Horn J, Kuiper M, Pellis T, Stammet P, Wise MP, Åneman A, Bugge JF. A low body temperature on arrival at hospital following out-of-hospital-cardiac-arrest is associated with increased mortality in the TTM-study. Resuscitation 2016; 107:102-6. [PMID: 27565034 DOI: 10.1016/j.resuscitation.2016.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
AIM To investigate the association of temperature on arrival to hospital after out-of-hospital-cardiac arrest (OHCA) with the primary outcome of mortality, in the targeted temperature management (TTM) trial. METHODS The TTM trial randomized 939 patients to TTM at 33 or 36°C for 24h. Patients were categorized according to their recorded body temperature on arrival and also categorized to groups of patients being actively cooled or passively rewarmed. RESULTS OHCA patients having a temperature ≤34.0°C on arrival at hospital had a significantly higher mortality compared to the OHCA patients with a higher temperature on arrival. A low body temperature on arrival was associated with a longer time to return of spontaneous circulation (ROSC) and duration of transport time to hospital. Patients who were actively cooled or passively rewarmed during the first 4h had similar mortality. In a multivariate logistic regression model mortality was significantly related to time from OHCA to ROSC, time from OHCA to advanced life support (ALS), age, sex and first registered rhythm. None of the temperature related variables (included the TTM-groups) were significantly related to mortality. CONCLUSION OHCA patients with a temperature ≤34.0°C on arrival have a higher mortality than patients with a temperature ≥34.1°C on arrival. A low temperature on arrival is associated with a long time to ROSC. Temperature changes and TTM-groups were not associated with mortality in a regression model.
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Affiliation(s)
- Jan Hovdenes
- Department of Anesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Kjetil Røysland
- Department of Biostatistics, Institute of Basical Medical Sciences, University of Oslo, Norway
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Jesper Kjaergaard
- The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Wanscher
- The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Tobias Cronberg
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences Lund University, Skåne University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Anesthesia and Intensive Care, Skåne University Hospital, Lund, University of Lund, Sweden
| | - Yvan Gasche
- Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - Michael Kuiper
- Department of Intensive Care, Medical Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Tommaso Pellis
- Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy
| | - Pascal Stammet
- Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg
| | - Matthew P Wise
- Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Anders Åneman
- Department of Intensive Care, Liverpool hospital, Sydney, New South Wales, Australia
| | - Jan Frederik Bugge
- Department of Anesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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12
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Greater temperature variability is not associated with a worse neurological outcome after cardiac arrest. Resuscitation 2015; 96:268-74. [DOI: 10.1016/j.resuscitation.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 08/19/2015] [Accepted: 09/04/2015] [Indexed: 11/23/2022]
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Abstract
Since their introduction over 40 years ago, paramedics have been trained to deliver select advanced life support interventions in the community with the goal of reducing morbidity and mortality from cardiovascular disease and trauma. The ensuing decades witnessed a great deal of interest in paramedic care, with an exponential growth in prehospital resuscitation research. As part of the CJEM series on emergency medical services (EMS), we review recent prehospital research in out-of-hospital cardiac arrest and discuss how, in a novel departure from the origins of EMS, prehospital research is beginning to influence in-hospital care. We discuss emerging areas of study related to cardiopulmonary resuscitation (CPR) quality, therapeutic hypothermia, termination of resuscitation, and the use of end-tidal carbon dioxide measurement, as well as the subtle ripple effects that prehospital research is having on the broader understanding of the management of these critically ill patients.
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14
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Implementation Science and Targeted Temperature Management. Crit Care Med 2015; 43:1135-6. [DOI: 10.1097/ccm.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Prehospital initiation of mild therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA): where are we now? CAN J EMERG MED 2015; 17:227-30. [DOI: 10.1017/cem.2015.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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If there is a “time to target temperature paradox” in post-cardiac arrest care, would we know? Resuscitation 2015; 88:A3-4. [DOI: 10.1016/j.resuscitation.2014.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
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Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large prospective registry*. Crit Care Med 2015; 42:2537-45. [PMID: 25083981 DOI: 10.1097/ccm.0000000000000543] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite a lack of randomized trials, practice guidelines recommend that mild induced hypothermia be considered for comatose survivors of in-hospital cardiac arrest. This study describes the safety, feasibility, and outcomes of mild induced hypothermia treatment following in-hospital cardiac arrest. DESIGN Prospective, observational, registry-based study. SETTING Forty-six critical care facilities in eight countries in Europe and the United States reporting in the Hypothermia Network Registry and the International Cardiac Arrest Registry. PATIENTS A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A cerebral performance category of 1 or 2 was considered a good outcome. At hospital discharge 41% of patients had a good outcome. At median 6-month follow-up, 34% had a good outcome. Among in-hospital deaths, 52% were of cardiac causes and 44% of cerebral cause. A higher initial body temperature was associated with reduced odds of a good outcome (odds ratio, 0.79; 95% CI, 0.68-0.92). Adverse events were common; bleeding requiring transfusion (odds ratio, 0.56; 95% CI, 0.31-1.00) and sepsis (odds ratio, 0.52; 95% CI, 0.30-0.91) were associated with reduced odds for a good outcome. CONCLUSIONS In this registry study of an in-hospital cardiac arrest population treated with mild induced hypothermia, we found a 41% good outcome at hospital discharge and 34% at follow-up. Infectious complications occurred in 43% of cases, and 11% of patients required a transfusion for bleeding. The majority of deaths were of cardiac origin.
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Targeted temperature management processes and outcomes after out-of-hospital cardiac arrest: an observational cohort study*. Crit Care Med 2015; 42:2565-74. [PMID: 25188550 DOI: 10.1097/ccm.0000000000000551] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Targeted temperature management has been shown to improve survival with good neurological outcome in patients after out-of-hospital cardiac arrest. The optimal approach to inducing and maintaining targeted temperature management, however, remains uncertain. The objective of this study was to evaluate these processes of care with survival and neurological function in patients after out-of-hospital cardiac arrest. DESIGN An observational cohort study evaluating the association of targeted temperature management processes with survival and neurological function using bivariate and generalized estimating equation analyses. SETTING Thirty-two tertiary and community hospitals in eight urban and rural regions of southern Ontario, Canada. PATIENTS Consecutive adult (≥ 18 yr) patients admitted between November 1, 2007, and January 31, 2012, and who were treated with targeted temperature management following nontraumatic out-of-hospital cardiac arrest. INTERVENTIONS Evaluate the association of targeted temperature management processes with survival and neurologic function using bivariate and generalized estimating equation analyses. MEASUREMENTS AND MAIN RESULTS There were 5,770 consecutive out-of-hospital cardiac arrest patients, of whom 747 (12.9%) were eligible and received targeted temperature management. Among patients with available outcome data, 365 of 738 (49.5%) survived to hospital discharge and 241 of 675 (35.7%) had good neurological outcomes. After adjusting for the Utstein variables, a higher temperature prior to initiation of targeted temperature management was associated with improved neurological outcomes (odds ratio, 1.27 per °C; 95% CI, 1.08-1.50; p = 0.004) and survival (odds ratio, 1.26 per °C; 95% CI, 1.09-1.46; p = 0.002). A slower rate of cooling was associated with improved neurological outcomes (odds ratio, 0.74 per °C/hr; 95% CI, 0.57-0.97; p = 0.03) and survival (odds ratio, 0.73 per °C/hr; 95% CI, 0.54-1.00; p = 0.049). CONCLUSIONS A higher baseline temperature prior to initiation of targeted temperature management and a slower rate of cooling were associated with improved survival and neurological outcomes. This may reflect a complex relationship between the approach to targeted temperature management and the extent of underlying brain injury causing impaired thermoregulation in out-of-hospital cardiac arrest patients.
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Storm C, Meyer T, Schroeder T, Wutzler A, Jörres A, Leithner C. Use of target temperature management after cardiac arrest in Germany – A nationwide survey including 951 intensive care units. Resuscitation 2014; 85:1012-7. [DOI: 10.1016/j.resuscitation.2014.04.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/23/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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Murnin MR, Sonder P, Janssens GN, Henry CL, Polderman KH, Rittenberger JC, Dezfulian C. Determinants of heat generation in patients treated with therapeutic hypothermia following cardiac arrest. J Am Heart Assoc 2014; 3:e000580. [PMID: 24780205 PMCID: PMC4309044 DOI: 10.1161/jaha.113.000580] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Therapeutic hypothermia (TH) is recommended to reduce ischemic brain injury after cardiac arrest. The variables that predict heat generation by patients receiving TH are uncertain, as is how this heat generation relates to neurologic outcome. We hypothesized that patient characteristics, medication use, inflammation, and organ injury would be associated with heat generation. We further hypothesized that neurologic outcome would be most strongly associated with heat generation. Methods and Results Surface and intravascular cooling devices were used to provide TH in 57 consecutive cardiac arrest patients. Device water temperatures during the maintenance (33°C) phase were collected. Patient heat generation was quantified as the “heat index” (HI), which was the inverse average water temperature over a minimum of 2 hours of maintenance hypothermia. Variables measuring reduced ischemic injury and improved baseline health were significantly associated with HI. After controlling for presenting rhythm, a higher HI was independently associated with favorable disposition (OR=2.2; 95% CI 1.2 to 4.1; P=0.014) and favorable Cerebral Performance Category (OR=1.8; 95% CI 1.0 to 3.1; P=0.035). Higher HI predicted favorable disposition (receiver‐operator area under the curve 0.71, P=0.029). HI was linearly correlated with arteriovenous CO2 (r=0.69; P=0.041) but not O2 (r=0.13; P=0.741) gradients. Conclusions In cardiac arrest patients receiving TH, greater heat generation is associated with better baseline health, reduced ischemic injury, and improved neurologic function, which results in higher metabolism. HI can control for confounding effects of patient heat generation in future clinical trials of rapid TH and offers early prognostic information.
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Affiliation(s)
- Matthew R Murnin
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
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21
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Buijs EAB, Verboom EM, Top APC, Andrinopoulou ER, Buysse CMP, Ince C, Tibboel D. Early microcirculatory impairment during therapeutic hypothermia is associated with poor outcome in post-cardiac arrest children: a prospective observational cohort study. Resuscitation 2013; 85:397-404. [PMID: 24200889 DOI: 10.1016/j.resuscitation.2013.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/22/2013] [Accepted: 10/22/2013] [Indexed: 12/21/2022]
Abstract
AIMS OF THE STUDY This study aimed to evaluate if the microcirculation is impaired during and after therapeutic hypothermia (TH) in children with return of spontaneous circulation after cardiac arrest (CA) and to assess if microcirculatory impairment predicts mortality. This has been reported for post-CA adults, but results might be different for children because etiology, pathophysiology, and mortality rate differ. METHODS This prospective observational cohort study included consecutive, non-neonatal post-CA children receiving TH upon intensive care admission between June 2008 and June 2012. Also included were gender-matched and age-matched normothermic, control children without cardiorespiratory disease. The buccal microcirculation was non-invasively assessed with Sidestream Dark Field Imaging at the start of TH, halfway during TH, at the start of re-warming, and at normothermia. Macrocirculatory, respiratory, and biochemical parameters were also collected. RESULTS Twenty post-CA children were included of whom 9 died. During hypothermia, the microcirculation was impaired in the post-CA patients and did not change over time. At normothermia, the core body temperature and the microcirculation had increased and no longer differed from the controls. Microcirculatory deterioration was associated with mortality in the post-CA patients. In particular, the microcirculation was more severely impaired at TH start in the non-survivors than in the survivors - positive predictive value: 73-83, negative predictive value: 75-100, sensitivity: 63-100%, and specificity: 70-90%. CONCLUSIONS The microcirculation is impaired in post-CA children during TH and more severe impairment at TH start was associated with mortality. After the stop of TH, the microcirculation improves rapidly irrespective of outcome.
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Affiliation(s)
- Erik A B Buijs
- Intensive Care and Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.
| | - Elyse M Verboom
- Intensive Care and Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.
| | - Anke P C Top
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.
| | | | - Corinne M P Buysse
- Intensive Care and Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.
| | - Can Ince
- Intensive Care, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.
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Donadello K, Scolletta S, Taccone FS. Letter: Is early hypothermia deleterious in comatose survivors to cardiac arrest? Resuscitation 2013; 84:e35-6. [DOI: 10.1016/j.resuscitation.2012.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 03/06/2012] [Indexed: 10/27/2022]
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Clarke S, Lyon RM, Short S, Crookston C, Clegg GR. A specialist, second-tier response to out-of-hospital cardiac arrest: setting up TOPCAT2: Table 1. Emerg Med J 2013; 31:405-7. [DOI: 10.1136/emermed-2012-202232] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Predictors of external cooling failure after cardiac arrest. Intensive Care Med 2013; 39:620-8. [DOI: 10.1007/s00134-012-2794-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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25
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Shin J, Kim J, Song K, Kwak Y. Core temperature measurement in therapeutic hypothermia according to different phases: comparison of bladder, rectal, and tympanic versus pulmonary artery methods. Resuscitation 2013; 84:810-7. [PMID: 23306812 DOI: 10.1016/j.resuscitation.2012.12.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/19/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Comparisons of bladder, rectal and tympanic temperatures versus pulmonary artery (PA) temperature during different therapeutic hypothermia (TH) phases. METHODS Twenty-one patients admitted to our emergency department (ED) after out-of-hospital cardiac arrests were included in this study. For comparison, the temperature of four different sites, urinary bladder (BL), rectal (RE), tympanic membrane (TM) digital thermometers, and a Swan-Ganz catheter were used during TH, which were controlled by a surface cooling method. TH is divided into three phases: induction, maintenance, and rewarming phase. RESULTS In the induction phase, the mean differences between PA temperatures and those of the other methods studied were: BL (-0.24 ± 1.30°C), RE (-0.52 ± 1.40°C), and TM (1.11 ± 1.53°C). The mean differences between PA temperatures and those of the other methods in the maintenance phase were BL (0.06 ± 0.79°C), RE (-0.30 ± 1.16°C), and TM (1.12 ± 1.29°C); in the rewarming phase: BL (0.08 ± 0.86°C), RE (-0.03 ± 1.71°C), and TM (0.89 ± 1.62°C); and in the total phase: BL (0.04 ± 0.90°C), RE (-0.22 ± 1.44°C), and TM (1.03 ± 1.47°C). CONCLUSIONS The mean difference between BL and PA temperatures is lower than those in other sites during TH. On the contrary, there are larger differences between TM and PA temperatures when compared to other sites. The differences between RE and PA temperatures are comparatively less than those between TM and PA. However, RE temperature tends to be higher than the temperature recorded by a BL thermometer or Swan-Ganz catheter during the rapid induction phase.
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Affiliation(s)
- Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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Abstract
The best chance of survival with a good neurological outcome after cardiac arrest is afforded by early recognition and high-quality cardiopulmonary resuscitation (CPR), early defibrillation of ventricular fibrillation (VF), and subsequent care in a specialist center. Compression-only CPR should be used by responders who are unable or unwilling to perform mouth-to-mouth ventilations. After the first defibrillator shock, further rhythm checks and defibrillation attempts should be performed after 2 min of CPR. The underlying cause of cardiac arrest can be identified and treated during CPR. Drugs have a limited effect on long-term outcomes after cardiac arrest, although epinephrine improves the success of resuscitation, and amiodarone increases the success of defibrillation for refractory VF. Supraglottic airway devices are an alternative to tracheal intubation, which should be attempted only by skilled rescuers. Care after cardiac arrest includes controlled reoxygenation, therapeutic hypothermia for comatose survivors, percutaneous coronary intervention, circulatory support, and control of blood-glucose levels and seizures. Prognostication in comatose survivors of cardiac arrest needs a careful, multimodal approach using clinical and electrophysiological assessments after at least 72 h.
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Affiliation(s)
- Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Combe Park, Bath BA1 3NG, UK
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27
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Sunde K. Rewarming after therapeutic hypothermia. Resuscitation 2012; 83:930-1. [PMID: 22664744 DOI: 10.1016/j.resuscitation.2012.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 05/26/2012] [Indexed: 11/26/2022]
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Spontaneous cooling and rewarming after cardiac arrest may not be therapeutic. Resuscitation 2012; 83:283-4. [DOI: 10.1016/j.resuscitation.2011.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 12/29/2011] [Indexed: 11/20/2022]
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Benz-Woerner J, Delodder F, Benz R, Cueni-Villoz N, Feihl F, Rossetti AO, Liaudet L, Oddo M. Body temperature regulation and outcome after cardiac arrest and therapeutic hypothermia. Resuscitation 2012; 83:338-42. [PMID: 22079947 DOI: 10.1016/j.resuscitation.2011.10.026] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 10/21/2011] [Accepted: 10/30/2011] [Indexed: 10/15/2022]
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Lyon RM, Clegg GR. Pre-hospital cooling for out-of-hospital cardiac arrest--more research required. Resuscitation 2011; 82:1108-9. [PMID: 21636203 DOI: 10.1016/j.resuscitation.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/19/2022]
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Haugk M, Testori C, Sterz F, Uranitsch M, Holzer M, Behringer W, Herkner H. Relationship between time to target temperature and outcome in patients treated with therapeutic hypothermia after cardiac arrest. Crit Care 2011; 15:R101. [PMID: 21439038 PMCID: PMC3219373 DOI: 10.1186/cc10116] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 02/11/2011] [Accepted: 03/25/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Our purpose was to study whether the time to target temperature correlates with neurologic outcome in patients after cardiac arrest with restoration of spontaneous circulation treated with therapeutic mild hypothermia in an academic emergency department. METHODS Temperature data between April 1995 and June 2008 were collected from 588 patients and analyzed in a retrospective cohort study by observers blinded to outcome. The time needed to achieve an esophageal temperature of less than 34°C was recorded. Survival and neurological outcomes were determined within six months after cardiac arrest. RESULTS The median time from restoration of spontaneous circulation to reaching a temperature of less than 34°C was 209 minutes (interquartile range [IQR]: 130-302) in patients with favorable neurological outcomes compared to 158 min (IQR: 101-230) (P < 0.01) in patients with unfavorable neurological outcomes. The adjusted odds ratio for a favorable neurological outcome with a longer time to target temperature was 1.86 (95% CI 1.03 to 3.38, P = 0.04). CONCLUSIONS In comatose cardiac arrest patients treated with therapeutic hypothermia after return of spontaneous circulation, a faster decline in body temperature to the 34°C target appears to predict an unfavorable neurologic outcome.
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Affiliation(s)
- Moritz Haugk
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, 1090, Austria
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, 1090, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, 1090, Austria
| | - Maximilian Uranitsch
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, 1090, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, 1090, Austria
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, 1090, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, Wien, 1090, Austria
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Therapeutic hypothermia post out-of-hospital cardiac arrest - more questions than answers? Crit Care 2011; 15:151. [PMID: 21542884 PMCID: PMC3219380 DOI: 10.1186/cc10123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wörner J, Oddo M. Too cold may not be so cool: spontaneous hypothermia as a marker of poor outcome after cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:1002. [PMID: 21067559 PMCID: PMC3219270 DOI: 10.1186/cc9270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In a recent issue of Critical Care, den Hartog and colleagues show an association between spontaneous hypothermia, defined by an admission body temperature <35°C, and poor outcome in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH). Given that TH alters neurological prognostication, studies aiming to identify early markers of injury severity and outcome are welcome, since they may contribute overall to optimize the management of comatose CA patients. This study provides an important message to clinicians involved in post-resuscitation care and raises important questions that need to be taken into account in future studies.
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Affiliation(s)
- Jakobea Wörner
- Department of Intensive Care Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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