Advertisement

Early Cooling in Cardiac Arrest: What is the Evidence?

  • L. Hammer
  • C. Adrie
  • J. -F. Timsit
Conference paper

Abstract

Cardiac arrest is a major cause of unexpected death in developed countries, with survival rates ranging from less than 5% to 35% [1, 2]. In patients who are initially resuscitated, anoxic neurological injury is an important cause of morbidity and mortality [3]. For successful resuscitation, rapid return to spontaneous circulation is mandatory, but overcoming post-resuscitation tissue injury is necessary as well [4, 5]. Various treatment strategies have been used to attenuate ischemic-related pathophysiological damage and behavioral deficits. Prolonged therapeutic hypothermia is the only post-resuscitation therapy clinically demonstrated to improve the outcome of cardiac arrest survivors [6, 7, 8, 9]. Therapeutic hypothermia is recommended by the International Liaison Committee on Resuscitation (ILCOR) [8].

Keywords

Cardiac Arrest Therapeutic Hypothermia Mild Hypothermia Spontaneous Circulation Cold Fluid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR (1990) Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med 19:179–186PubMedCrossRefGoogle Scholar
  2. 2.
    Bernard S (1998) Outcome from prehospital cardiac arrest in Melbourne, Australia. Emerg Med 10:25–29Google Scholar
  3. 3.
    Edgren E, Hedstrand U, Kelsey S, Sutton-Tyrrell K, Safar P (1994) Assessment of neurological prognosis in comatose survivors of cardiac arrest. BRCT I Study Group. Lancet 343:1055–1059PubMedCrossRefGoogle Scholar
  4. 4.
    Cummins RO, Ornato JP, Thies WH, Pepe PE (1991) Improving survival from sudden cardiac arrest: the „chain of survival“ concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 83:1832–1847PubMedGoogle Scholar
  5. 5.
    Safar P (1988) Resuscitation from clinical death: pathophysiologic limits and therapeutic potentials. Crit Care Med 16:923–941PubMedCrossRefGoogle Scholar
  6. 6.
    Bernard SA, Gray TW, Buist MD, et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563PubMedCrossRefGoogle Scholar
  7. 7.
    Group HACAS (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556CrossRefGoogle Scholar
  8. 8.
    Nolan JP, Morley PT, Hoek TL, Hickey RW (2003) Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation 57:231–235PubMedCrossRefGoogle Scholar
  9. 9.
    Holzer M, Bernard SA, Hachimi-Idrissi S, Roine RO, Sterz F, Mullner M (2005) Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data metaanalysis. Crit Care Med 33:414–418PubMedCrossRefGoogle Scholar
  10. 10.
    Gundersen Y, Vaagenes P, Pharo A, Valo ET, Opstad PK (2001) Moderate hypothermia blunts the inflammatory response and reduces organ injury after acute haemorrhage. Acta Anaesthesiol Scand 45:994–1001PubMedCrossRefGoogle Scholar
  11. 11.
    Vazquez-Jimenez JF, Qing M, Hermanns B, et al (2001) Moderate hypothermia during cardiopulmonary bypass reduces myocardial cell damage and myocardial cell death related to cardiac surgery. J Am Coll Cardiol 38:1216–1223PubMedCrossRefGoogle Scholar
  12. 12.
    Kimura A, Sakurada S, Ohkuni H, Todome Y, Kurata K (2002) Moderate hypothermia delays proinflammatory cytokine production of human peripheral blood mononuclear cells. Crit Care Med 30:1499–1502PubMedCrossRefGoogle Scholar
  13. 13.
    Adrie C, Adib-Conquy M, Laurent I, et al (2002) Successful cardiopulmonary resuscitation after cardiac arrest as a „sepsis-like“ syndrome. Circulation 106:562–568PubMedCrossRefGoogle Scholar
  14. 14.
    Negovsky VA, Gurvitch AM (1995) Post-resuscitation disease — a new nosological entity. Its reality and significance. Resuscitation 30:23–27PubMedCrossRefGoogle Scholar
  15. 15.
    Ning XH, Chen SH, Xu CS, et al (2002) Hypothermic protection of the ischemic heart via alterations in apoptotic pathways as assessed by gene array analysis. J Appl Physiol 92:2200–2207PubMedGoogle Scholar
  16. 16.
    Polderman KH (2004) Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence. Intensive Care Med 30:556–575PubMedCrossRefGoogle Scholar
  17. 17.
    Kuboyama K, Safar P, Radovsky A, Tisherman SA, Stezoski SW, Alexander H (1993) Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study. Crit Care Med 21:1348–1358PubMedCrossRefGoogle Scholar
  18. 18.
    Abella BS, Zhao D, Alvarado J, Hamann K, Vanden Hoek TL, Becker LB (2004) Intra-arrest cooling improves outcomes in a murine cardiac arrest model. Circulation 109:2786–2791PubMedCrossRefGoogle Scholar
  19. 19.
    Takata K, Takeda Y, Sato T, Nakatsuka H, Yokoyama M, Morita K (2005) Effects of hypothermia for a short period on histologic outcome and extracellular glutamate concentration during and after cardiac arrest in rats. Crit Care Med 33:1340–1345PubMedCrossRefGoogle Scholar
  20. 20.
    Nozari A, Safar P, Stezoski SW, et al (2006) Critical time window for intra-arrest cooling with cold saline flush in a dog model of cardiopulmonary resuscitation. Circulation 113:2690–2696PubMedCrossRefGoogle Scholar
  21. 21.
    Markarian GZ, Lee JH, Stein DJ, Hong SC (1996) Mild hypothermia: therapeutic window after experimental cerebral ischemia. Neurosurgery 38:542–550PubMedCrossRefGoogle Scholar
  22. 22.
    Colbourne F, Corbett D (1995) Delayed postischemic hypothermia: a six month survival study using behavioral and histological assessments of neuroprotection. J Neurosci 15: 7250–7260PubMedGoogle Scholar
  23. 23.
    Shao ZH, Chang WT, Chan KC, et al (2007) Hypothermia-induced cardioprotection using extended ischemia and early reperfusion cooling. Am J Physiol 292:H1995–2003Google Scholar
  24. 24.
    Wagner BP, Nedelcu J, Martin E (2002) Delayed postischemic hypothermia improves longterm behavioral outcome after cerebral hypoxia-ischemia in neonatal rats. Pediatr Res 51: 354–360PubMedCrossRefGoogle Scholar
  25. 25.
    Hicks SD, DeFranco DB, Callaway CW (2000) Hypothermia during reperfusion after asphyxiai cardiac arrest improves functional recovery and selectively alters stress-induced protein expression. J Cereb Blood Flow Metab 20:520–530PubMedCrossRefGoogle Scholar
  26. 26.
    Lawrence EJ, Dentcheva E, Curtis KM, Roberts VL, Siman R, Neumar RW (2005) Neuroprotection with delayed initiation of prolonged hypothermia after in vitro transient global brain ischemia. Resuscitation 64:383–388PubMedCrossRefGoogle Scholar
  27. 27.
    Safar P, Xiao F, Radovsky A, et al (1996) Improved cerebral resuscitation from cardiac arrest in dogs with mild hypothermia plus blood flow promotion. Stroke 27:105–113PubMedGoogle Scholar
  28. 28.
    Dixon SR, Whitbourn RJ, Dae MW, et al (2002) Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction. J Am Coll Cardiol 40:1928–1934PubMedCrossRefGoogle Scholar
  29. 29.
    Ly HQ, Denault A, Dupuis J, et al (2005) A pilot study: the Noninvasive Surface Cooling Thermoregulatory System for Mild Hypothermia Induction in Acute Myocardial Infarction (the NICAMI Study). Am Heart J 150:933.e9–el3CrossRefGoogle Scholar
  30. 30.
    Hale SL, Kloner RA (1997) Myocardial temperature in acute myocardial infarction: protection with mild regional hypothermia. Am J Physiol 273:H220–227PubMedGoogle Scholar
  31. 31.
    Boddicker KA, Zhang Y, Zimmerman MB, Davies LR, Kerber RE (2005) Hypothermia improves defibrillation success and resuscitation outcomes from ventricular fibrillation. Circulation 111:3195–3201PubMedCrossRefGoogle Scholar
  32. 32.
    Kim F, Olsufka M, Carlbom D, et al (2005) 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 112:715–719PubMedCrossRefGoogle Scholar
  33. 33.
    Bernard S, Buist M, Monteiro O, Smith K (2003) Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 56:9–13PubMedCrossRefGoogle Scholar
  34. 34.
    Kliegel A, Janata A, Wandaller C, et al (2007) Cold infusions alone are effective for induction of therapeutic hypothermia but do not keep patients cool after cardiac arrest. Resuscitation 73:46–53PubMedCrossRefGoogle Scholar
  35. 35.
    Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes AR (2005) Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med 33:2744–2751PubMedCrossRefGoogle Scholar
  36. 36.
    Kim F, Olsufka M, Longstreth WT, et al (2007) Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation 115:3064–3070PubMedCrossRefGoogle Scholar
  37. 37.
    Hammer L, Savary D, Debaty G, et al (2007) Immediate pre-hospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Intensive Care Med 33:S105 (abst)Google Scholar
  38. 38.
    Virkkunen I, Yli-Hankala A, Silfvast T (2004) Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer’s solution: a pilot study. Resuscitation 62:299–302Google Scholar
  39. 39.
    Oddo M, Schaller MD, Feihl F, Ribordy V, Liaudet L (2006) From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med 34:1865–1873PubMedGoogle Scholar
  40. 40.
    Feiberg RA, Krieger DW, Chuang R, at al (2001) Hypothermia after cardiac arrest: feasibility and safety of an external cooling protocol. Circulation 104:1799–1804CrossRefGoogle Scholar
  41. 41.
    Zeiner A, Holzer M, Sterz F, et al (2000) Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group. Stroke 31:86–94PubMedGoogle Scholar
  42. 42.
    Al-Senani FM, Graffagnino C, Grotta JC, et al (2004) A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGard System and Icy catheter following cardiac arrest. Resuscitation 62:143–150PubMedCrossRefGoogle Scholar
  43. 43.
    Laurent I, Adrie C, Vinsonneau C, et al (2005) High-volume hemofiltration after out-of-hospital cardiac arrest: a randomized study. J Am Coll Cardiol 46:432–437PubMedCrossRefGoogle Scholar
  44. 44.
    Arrich J (2007) Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 35:1041–1047PubMedCrossRefGoogle Scholar
  45. 45.
    Belliard G, Catez E, Charron C, et al (2007) Efficacy of therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation. Resuscitation 75:252–259PubMedCrossRefGoogle Scholar
  46. 46.
    Haugk M, Sterz F, Grassberger M, etal (2007) Feasibility and efficacy of a new non-invasive surface cooling device in post-resuscitation intensive care medicine. Resuscitation 75:76–81PubMedCrossRefGoogle Scholar
  47. 47.
    Holzer M, Behringer W, Janata A, et al (2005) Extracorporeal venovenous cooling for induction of mild hypothermia in human-sized swine. Crit Care Med 33:1346–1350PubMedCrossRefGoogle Scholar
  48. 48.
    Hachimi-Idrissi S, Corne L, Ebinger G, Michotte Y, Huyghens L (2001) Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 51:275–281PubMedCrossRefGoogle Scholar
  49. 49.
    Bayegan K, Janata A, Frossard M, et al (2007) Rapid non-invasive external cooling to induce mild therapeutic hypothermia in adult human-sized swine. Resuscitation [Epub ahead of print]Google Scholar
  50. 50.
    Bernard SA, Rosalion A(2007) Therapeutic hypothermia induced during cardiopulmonary resuscitation using large-volume, ice-cold intravenous fluid. Resuscitation [Epub ahead of print]Google Scholar

Copyright information

© Springer Science + Business Media Inc. 2008

Authors and Affiliations

  • L. Hammer
    • 1
  • C. Adrie
    • 2
  • J. -F. Timsit
    • 1
  1. 1.Department of Intensive CareGrenoble University HospitalGrenobleFrance
  2. 2.Department of Intensive CareDelafontaine HospitalSaint DenisFrance

Personalised recommendations