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Mild Therapeutic Hypothermia for Treatment of Cardiac Arrest: Current Results and Future Perspectives

  • W. Behringer
  • M. Holzer
  • F. Sterz
Conference paper

Abstract

Sudden cardiac arrest remains a major unresolved public health problem. It is still the leading cause of death, and few cardiopulmonary-cerebral resuscitation (CPCR) attempts on cardiac arrest victims result in neurologically intact long-term survivors [1,2].

Keywords

Cardiac Arrest Therapeutic Hypothermia Mild Hypothermia Cerebral Performance Category Moderate Hypothermia 
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.

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References

  1. 1.
    Eisenberg MS, Horwood BT, Cummins RO et al (1990) Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med 19:179–186PubMedCrossRefGoogle Scholar
  2. 2.
    Safar P, Behringer W (2003) Brain resuscitation after cardiac arrest. In: Layon AJ, Gabrielli A, Friedman W A(eds) Textbook of neurointensive care. Saunders, Philadelphia (in press)Google Scholar
  3. 3.
    Safar P (1997) Resuscitation of the ischemic brain. In: Albin MS (ed) Textbook of neuroanesthesia with neurosurgical and neuroscience perspectives. McGraw-Hill, New York, pp 557–593Google Scholar
  4. 4.
    Siesjo BK ( 1988) Mechanisms of ischemic brain damage. Crit Care Med 16:954–963PubMedCrossRefGoogle Scholar
  5. 5.
    White BC, Sullivan JM, DeGracia DJ et al (2000) Brain ischemia and reperfusion: molecular mechanisms of neuronal injury. J Neurol Sci 179:1–33PubMedCrossRefGoogle Scholar
  6. 6.
    Michenfelder JD, Theye RA (1970) The effects of anesthesia and hypothermia on canine cerebral ATP and lactate during anoxia produced by decapitation. Anesthesiology 33:430–439PubMedCrossRefGoogle Scholar
  7. 7.
    Safar P (1986) Cerebral resuscitation after cardiac arrest: a review. Circulation 74:IV138–IV153PubMedGoogle Scholar
  8. 8.
    Safar P (1988) Resuscitation from clinical death: pathophysiologic limits and therapeutic potentials. Crit Care Med 16:923–941PubMedCrossRefGoogle Scholar
  9. 9.
    Reuler JB (1978) Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med 89:519–527PubMedGoogle Scholar
  10. 10.
    Bigelow WG, Linsay WK, Greenwood WF (1950) Hypothermia: its possible role in cardiac surgery. Ann Surg 132:849–866PubMedCrossRefGoogle Scholar
  11. 11.
    Rosomoff HL, Holaday A (1954) Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol 179:85–88PubMedGoogle Scholar
  12. 12.
    Dripps RD (1956) The physiology of induced hypothermia. National Academy of Science, Washington DCGoogle Scholar
  13. 13.
    Steen PA, Soule EH, Michenfelder JD (1979) Detrimental effect of prolonged hypothermia in cats and monkeys with and without regional cerebral ischemia. Stroke 10:522–529PubMedCrossRefGoogle Scholar
  14. 14.
    Steen PA, Milde JH, Michenfelder JD (1980) The detrimental effects of prolonged hypothermia and rewarming in the dog. Anesthesiology 52:224–230PubMedCrossRefGoogle Scholar
  15. 15.
    Busto R, Dietrich WD, Globus MY et al (1987) Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 7:729–738PubMedCrossRefGoogle Scholar
  16. 16.
    Hossmann KA (1988) Resuscitation potentials after prolonged global cerebral ischemia in cats. Crit Care Med 16:964–971PubMedCrossRefGoogle Scholar
  17. 17.
    Leonov Y, Sterz F, Safar P, Radovsky A (1990) Moderate hypothermia after cardiac arrest of 17 minutes in dogs. Effect on cerebral and cardiac outcome. Stroke 21:1600–1606CrossRefGoogle Scholar
  18. 18.
    Leonov Y, Sterz F, Safar P et al (1990) Mild cerebral hypothermia during and after cardiac arrest improves neurologic outcome in dogs. J Cereb Blood Flow Metab 10:57–70PubMedCrossRefGoogle Scholar
  19. 19.
    Sterz F, Safar P, Tisherman S et al (1991) Mild hypothermic cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs. Crit Care Med 19:379–389PubMedCrossRefGoogle Scholar
  20. 20.
    Weinrauch V, Safar P, Tisherman S et al (1992) Beneficial effect of mild hypothermia and detrimental effect of deep hypothermia after cardiac arrest in dogs. Stroke 23:1454–1462PubMedCrossRefGoogle Scholar
  21. 21.
    Kuboyama K, Safar P, Radovsky A et al (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
  22. 22.
    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 27:105–113PubMedCrossRefGoogle Scholar
  23. 23.
    Coimbra C, Wieloch T (1994) Moderate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia. Acta Neuropathol 87:325–31PubMedCrossRefGoogle Scholar
  24. 24.
    Hickey RW, Ferimer H, Alexander HL et al (2000) Delayed, spontaneous hypothermia reduces neuronal damage after asphyxiai cardiac arrest in rats. Crit Care Med 28:3511–3516PubMedCrossRefGoogle Scholar
  25. 25.
    Green EJ, Dietrich WD, van Dijk F et al (1992) Protective effects of brain hypothermia on behavior and histopathology following global cerebral ischemia in rats. Brain Res 580:197–204PubMedCrossRefGoogle Scholar
  26. 26.
    Dietrich WD, Busto R, Alonso O et al (1993) Intraischemic but not postischemic brain hypothermia protects chronically following global forebrain ischemia in rats. J Cereb Blood Flow Metab 13:541–549PubMedCrossRefGoogle Scholar
  27. 27.
    Colbourne F, Corbett D (1994) Delayed and prolonged post-ischemic hypothermia is neuroprotective in the gerbil. Brain Res 654:265–72PubMedCrossRefGoogle Scholar
  28. 28.
    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
  29. 29.
    Colbourne F, Auer RN, Sutherland GR (1998) Behavioral testing does not exacerbate ischemic CA1 damage in gerbils. Stroke 29:1967–1970PubMedCrossRefGoogle Scholar
  30. 30.
    Colbourne F, Li H, Buchan AM (1999) Indefatigable CA1 sector neuroprotection with mild hypothermia induced 6 hours after severe forebrain ischemia in rats. J Cereb Blood Flow Metab 19:742–749PubMedCrossRefGoogle Scholar
  31. 31.
    Bernard SA, Jones BM, Home MK (1997) Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med 30:146–153PubMedCrossRefGoogle Scholar
  32. 32.
    Yanagawa Y, Ishihara S, Norio H et al (1998) Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest. Resuscitation 39:61–66PubMedCrossRefGoogle Scholar
  33. 33.
    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 31:86–94Google Scholar
  34. 34.
    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
  35. 35.
    Hypothermia After Cardiac ARrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556CrossRefGoogle Scholar
  36. 36.
    Baumgardner JE, Baranov D, Smith DS, Zager EL (1999) The effectiveness of rapidly infused intravenous fluids for inducing moderate hypothermia in neurosurgical patients. Anesth Analg 89:163–169PubMedGoogle Scholar
  37. 37.
    Rajek A, Greif R, Sessler DI et al (2000) Core cooling by central venous infusion of ice-cold (4 degrees C and 20 degrees C) fluid: isolation of core and peripheral thermal compartments. Anesthesiology 93:629–637PubMedCrossRefGoogle Scholar
  38. 38.
    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
  39. 39.
    Behringer W, Safar P, Wu X et al (2002) Veno-venous extracorporeal blood shunt cooling to induce mild hypothermia in dog experiments and review of cooling methods. Resuscitation 54:89–98PubMedCrossRefGoogle Scholar
  40. 40.
    Keller E, Imhof HG, Gasser S et al (2003) Endovascular cooling with heat exchange catheters: a new method to induce and maintain hypothermia. Intensive Care Med 29:939–943PubMedGoogle Scholar
  41. 41.
    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
  42. 42.
    Safar P, Tisherman SA, Behringer W et al (2000) Suspended animation for delayed resuscitation from prolonged cardiac arrest that is unresuscitable by standard cardio-pulmonary-cerebral resuscitation. Crit Care Med 28:N214-N218Google Scholar
  43. 43.
    Safar P, Abramson NS, Angelos M et al (1990) Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest. Am J Emerg Med 8:55–67PubMedCrossRefGoogle Scholar
  44. 44.
    Bellamy R, Safar P, Tisherman SA et al (1996) Suspended animation for delayed resuscitation. Crit Care Med 24:S24-S47Google Scholar
  45. 45.
    Hickey PR (1985) Deep hypothermic circulatory arrest: current status and future directions. Mt Sinai J Med 52:541–547PubMedGoogle Scholar
  46. 46.
    Livesay JJ, Cooley DA, Reul GJ et al (1983) Resection of aortic arch aneurysms: a comparison of hypothermic techniques in 60 patients. Ann Thorac Surg 36:19–28PubMedCrossRefGoogle Scholar
  47. 47.
    Capone A, Safar P, Radovsky A et al (1996) Complete recovery after normothermic hemorrhagic shock and profound hypothermie circulatory arrest of 60 minutes in dogs. J Trauma 40:388–395PubMedCrossRefGoogle Scholar
  48. 48.
    Tisherman SA, Safar P, Radovsky A et al (1991) Profound hypothermia (less than 10 degrees C) compared with deep hypothermia (15 degrees C) improves neurologic outcome in dogs after two hours’ circulatory arrest induced to enable resuscitative surgery. J Trauma 31:1051–1061PubMedGoogle Scholar
  49. 49.
    Woods RJ, Prueckner S, Safar P et al (1999) Hypothermie aortic arch flush for preservation during exsanguination cardiac arrest of 15 minutes in dogs. J Trauma 47:1028–1036PubMedCrossRefGoogle Scholar
  50. 50.
    Behringer W, Prueckner S, Safar P et al (2000) Rapid induction of mild cerebral hypothermia by cold aortic flush achieves normal recovery in a dog outcome model with 20-minute exsanguination cardiac arrest. Acad Emerg Med 7:1341–1348PubMedCrossRefGoogle Scholar
  51. 51.
    Behringer W, Prueckner S, Kentner R et al (2000) Rapid hypothermie aortic flush can achieve survival without brain damage after 30 minutes cardiac arrest in dogs. Anesthesiology 93:1491–1499PubMedCrossRefGoogle Scholar
  52. 52.
    Behringer W, Safar P, Wu X et al (2003) Survival without brain damage after clinical death of 60-120 mw in dogs using suspended animation by profound hypotermia. Crit Care Med 31:1523–1531PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • W. Behringer
    • 1
  • M. Holzer
    • 1
  • F. Sterz
    • 1
  1. 1.Department of Emergency MedicineVienna General HospitalAustria

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