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Therapeutic Hypothermia after cardiac arrest

Discussion in 'Emergency Medicine' started by waterski232002, Apr 21, 2007.

  1. waterski232002

    waterski232002 Senior Member 5+ Year Member

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    Sep 5, 2004
    Chicago
    I know about the HACA and Bernard studies... What other big studies were done on therapeutic hypothermia after cardiac arrest?
     
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  3. Dr.Evil1

    Dr.Evil1 Senior Member 7+ Year Member

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    Dec 6, 2004
    Myrtle Beach, SC
    I don't know the studies but I know that the neurologists here are really big on it. They give first hand reports of great neurologic outcomes after freezing people. I thought that Dr. Abella at U of C was big into freezing people too. Our neurologist expect a call from the resuscitation bay if we get ROC.
     
  4. Hawk22

    Hawk22 Senior Member 7+ Year Member

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    Jun 26, 2004
    North Carolina
    Are you looking for humans only or animal models too? Also, do you care about what method of cooling (i.e. cooling blankets, intra-arterial cooling devices, intra-nasal devices, helmets, etc.) were used?


    Here is a great review that might be helpful to find all of the original studies in one place:

    Holzer M, et. al. Hypothermia for neuroprotection after cardiac arrest:
    Systematic review and individual patient data meta-analysis. Crit Care Med 2005 Vol. 33, No. 2
     
  5. waterski232002

    waterski232002 Senior Member 5+ Year Member

    848
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    Sep 5, 2004
    Chicago
    Abella, Vandenhoek, Becker, and Beiser are the guys at UofC that were big into therapeutic hypothermia. I could just as easy ask them, but I've been at a conference all week. We don't employ it all the time, but maybe once or twice a month we'll do it in the ER.

    I'm also curious if anyone has come across any articles related to hypothermia in sepsis. The only articles I found on the topic were from the 1950's and 1960's....
     
  6. sleepymed

    sleepymed The white Hard24Get 7+ Year Member

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    Jun 24, 2005
    I'm doing a paper on this. I hadn't really heard this or come across this before (albeit I am only a fourth year med student) but it seems like such a nifty concept. I was impressed with some of the results I had come read about. How clinically relevant is this though? How many of you are actually doing this in your ED routinely?
     
  7. TysonCook

    TysonCook Senior Member Physician Faculty 10+ Year Member

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    Aug 19, 2002
    Carolinas Medical Center
    lots of articles and reviews in Resusc and journal of critical care medicine. I'll post some tomorrow (I did a 4th year project on it). I'll post some references as well.
    nnt is around 7, and when you compare to other therapies its pretty scary how well it can work.
     
  8. TysonCook

    TysonCook Senior Member Physician Faculty 10+ Year Member

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    Aug 19, 2002
    Carolinas Medical Center
    Here is a start...
    (1) Bernard SA, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. NEJM 2002; 346(8):557-563.
    (2) Holzer M, for the Hypothermia after arrest study group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. NEJM 2002; 346(8):549-556.
    (3) ILCOR advisory statement: Recommendations from advanced life support task force. Circulation 2003;108:118-121.
    (4) Hacimi-Idrissi S. Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 2001: Dec; 51(3): 275-81.
    (5) Bernard SA, et al. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 2003;56(1):9-13.
    (6) Polderman, et al., Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Critical Care Med 2005;33(12):2744-51.
    (7) Kim F, et al. 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. 2005 Aug 2;112(5):715-9
    (8) Kim F, et al. 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. 2007 Jun 19;115(24):3064-70.
     
  9. medivac

    medivac EM Supahstah 5+ Year Member

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    Mar 2, 2006
    North Carolina
    We just started it this fall at UNC, but had been doing it at our community program for awhile. I've been involved with several "freezings" out there, with many really amazing outcomes. I know peripherally about a few that walked out of the hospital without any neurologic sequelae whatsoever. UNC uses cooling blankets/saline, while our other site does central line cooling with a cool master machine chilling them out from the inside.
     
  10. Hard24Get

    Hard24Get The black sleepymed 7+ Year Member

    This is why Penn stole Becker and Abella :smuggrin:
     
  11. Hard24Get

    Hard24Get The black sleepymed 7+ Year Member

    sleepy, hon, make sure you include some of Dr. Becker's and Dr. Vandenhoek's, et al basic science work on this, so fascinating!:

    Intra-arrest cooling with delayed reperfusion yields higher survival than earlier normothermic resuscitation in a mouse model of cardiac arrest.

    Altering CO2 during reperfusion of ischemic cardiomyocytes modifies mitochondrial oxidant injury.

    Multiple effects of hypothermia on inflammatory response following ischemia-reperfusion injury in experimental ischemic neuropathy.


    Can't believe you never heard of it. We are doing it at Penn routinely. Where's KT when you need it? :confused:
     

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