| 1. |
- Friberg, Hans, et al.
(författare)
-
Hypothermia after Cardiac Arrest: Lessons Learned from National Registries.
- 2009
-
Ingår i: Journal of Neurotrauma. - : Mary Ann Liebert Inc. - 1557-9042 .- 0897-7151. ; 26, s. 365-369
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Therapeutic hypothermia has been shown to improve outcome in comatose survivors after cardiac arrest of cardiac origin. After the clinical implementation of this novel treatment, several international web-based registries were opened to facilitate the prospective collection of patient treatment data. The aim was to evaluate the actual use of hypothermia in clinical practice, safety aspects, resource utilization, and outcome in large cohorts of patients. There are two published studies from two separate registries, including 2205 cardiac arrest patients in 39 different sites, of whom 869 (39%) were treated with induced hypothermia. Another registry, The Hypothermia Registry, includes 1108 patients from 37 sites in six European countries and one center in the United States; a large majority, or 952 patients (86%), were treated with hypothermia. The three registries have different strengths and weaknesses, but the clinical outcome compares well with that of the two randomized trials. Our conclusions are that hypothermia is feasible to implement, that it seems reasonably safe, and that the outcome compares well with previous reports. We also conclude that the treatment with hypothermia after cardiac arrest is more widely applied than what is strictly evidence based.
|
|
| 2. |
|
|
| 3. |
- Nielsen, Niklas, et al.
(författare)
-
Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest
- 2009
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 53:7, s. 926-34
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Therapeutic hypothermia (TH) after cardiac arrest protects from neurological sequels and death and is recommended in guidelines. The Hypothermia Registry was founded to the monitor outcome, performance and complications of TH. METHODS: Data on out-of-hospital cardiac arrest (OHCA) patients admitted to intensive care for TH were registered. Hospital survival and long-term outcome (6-12 months) were documented using the Cerebral Performance Category (CPC) scale, CPC 1-2 representing a good outcome and 3-5 a bad outcome. RESULTS: From October 2004 to October 2008, 986 TH-treated OHCA patients of all causes were included in the registry. Long-term outcome was reported in 975 patients. The median time from arrest to initiation of TH was 90 min (interquartile range, 60-165 min) and time to achieving the target temperature (< or =34 degrees C) was 260 min (178-400 min). Half of the patients underwent coronary angiography and one-third underwent percutaneous coronary intervention (PCI). Higher age, longer time to return of spontaneous circulation, lower Glasgow Coma Scale at admission, unwitnessed arrest and initial rhythm asystole were all predictors of bad outcome, whereas time to initiation of TH and time to reach the goal temperature had no significant association. Bleeding requiring transfusion occurred in 4% of patients, with a significantly higher risk if angiography/PCI was performed (2.8% vs. 6.2%P=0.02). CONCLUSIONS: Half of the patients survived, with >90% having a good neurological function at long-term follow-up. Factors related to the timing of TH had no apparent association to outcome. The incidence of adverse events was acceptable but the risk of bleeding was increased if angiography/PCI was performed.
|
|
| 4. |
- Nielsen, Niklas, et al.
(författare)
-
Successful resuscitation with mechanical CPR, therapeutic hypothermia and coronary intervention during manual CPR after out-of-hospital cardiac arrest
- 2005
-
Ingår i: Resuscitation. - : Elsevier BV. - 1873-1570 .- 0300-9572. ; 65:1, s. 111-113
-
Tidskriftsartikel (refereegranskat)abstract
- A 62-year-old man suffered out-of-hospital cardiac arrest and was treated with mechanical compression-decompress ion during transport to the hospital. In the emergency department, 28 min after cardiac arrest, spontaneous circulation returned briefly but the patient rapidly became asystolic and mechanical compression-decompression was again applied. After further resuscitation a spontaneous circulation returned and the patient was transferred, deeply comatose, to the coronary intervention laboratory while therapeutic hypothermia was induced. In the laboratory the heart arrested again and coronary angiography was performed during manual CPR revealing a left main stem occlusion. After successful reperfusion of the heart the patient was transferred to the intensive care unit with an intra-aortic balloon pump. The patient was treated with hypothermia for 24 h and awoke without neurological sequelae after a sustained intensive care period of 13 days. The present case is an example of how modern resuscitation principles implementing new clinical and experimental findings may strengthen the chain of survival during resuscitation.
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
- Rundgren, Malin, et al.
(författare)
-
Neuron specific enolase and S-100B as predictors of outcome after cardiac arrest and induced hypothermia.
- 2009
-
Ingår i: Resuscitation. - : Elsevier BV. - 1873-1570 .- 0300-9572. ; 80, s. 784-789
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess the prognostic value of repetitive serum samples of neuron specific enolase (NSE) and S-100B in cardiac arrest patients treated with hypothermia. METHODS: In a three-centre study, comatose patients after cardiac arrest were treated with hypothermia at 33 degrees C for 24h, regardless of cause or the initial rhythm. Serum samples were collected at 2, 24, 48 and 72h after the arrest and analysed for NSE and S-100B in a non-blinded way. The cerebral performance categories scale (CPC) was used as the outcome measure; a best CPC of 1-2 during 6 months was regarded as a good outcome, a best CPC of 3-5 a poor outcome. RESULTS: One centre was omitted in the NSE analysis due to missing 24 and 48h samples. Two partially overlapping groups were studied, the NSE group (n=102) and the S-100B group (n=107). NSE at 48h >28mug/l (specificity 100%, sensitivity 67%) and S-100B >0.51mug/l at 24h (specificity 96%, sensitivity 62%) correlated with a poor outcome, and so did a rise in NSE of >2mug/l between 24 and 48h (odds ratio 9.8, CI 3.5-27.7). A majority of missing samples (n=123) were from the 2h sampling time (n=56) due to referral from other hospitals or inter-hospital transfer. CONCLUSION: NSE was a better marker than S-100B for predicting outcome after cardiac arrest and induced hypothermia. NSE above 28mug/l at 48h and a rise in NSE of more than 2mug/l between 24 and 48h were markers for a poor outcome.
|
|
