Top

Neurocritical Care

Published in:

01-10-2007 | Original Paper

Therapeutic Hypothermia after Cardiac Arrest: Performance Characteristics and Safety of Surface Cooling with or without Endovascular Cooling

Authors: Alexander C. Flint, J. Claude Hemphill, David C. Bonovich

Published in: Neurocritical Care | Issue 2/2007

Abstract

Introduction

Various methods are available to induce and maintain therapeutic hypothermia after cardiac arrest, but little data is available comparing device-mediated cooling to simple surface methods in this setting.

Methods

To assess the performance characteristics of simple surface cooling with or without an endovascular cooling catheter system, we retrospectively reviewed all cases of hypothermia for comatose survivors of cardiac arrest treated at a single academically affiliated urban hospital. Forty two comatose survivors of cardiac arrest were treated over a 3.5-year period. Hypothermia was induced and maintained by simple surface methods (ice packs, cooling blankets) with or without placement of an endovascular cooling catheter system with automated temperature feedback regulation.

Results

Overall, the rate of active cooling was not different between patients treated with endovascular catheter-assisted hypothermia and patients treated with surface cooling alone. However, use of a larger (14 F) catheter was associated with faster cooling rates. Maintenance of goal temperature (33°C) was far better controlled with the use of a cooling catheter. Use of surface cooling alone was associated with significant temperature overshoot. Patients treated with surface cooling alone spent more time bradycardic.

Conclusion

Use of an endovascular cooling catheter as part of a treatment protocol for hypothermia after cardiac arrest provides better control during maintenance of hypothermia, preventing temperature overshoot. Active cooling rates may be enhanced by the use of a larger cooling catheter.

Williams GR Jr, Spencer FC. The clinical use of hypothermia following cardiac arrest. Ann Surg 1958;148(3):462–8.PubMedCrossRef

Benson DW, Williams GR Jr., Spencer FC, Yates AJ. The use of hypothermia after cardiac arrest. Anesth Analg 1959;38:423–8.PubMedCrossRef

Feldman E, Rubin B, Surks SN. Beneficial effects of hypothermia after cardiac arrest. JAMA 1960;173:499–501.PubMed

Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346(8):557–63.PubMedCrossRef

Group HS. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346(8):549–56.CrossRef

Holzer M, Bernard SA, Hachimi-Idrissi S, Roine RO, Sterz F, Mullner M. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med 2005;33(2):414–8.PubMedCrossRef

American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7.5: Postresuscitation Support. Circulation 2005;112(24_suppl):IV-84–8.

Hazinski MF, Nadkarni VM, Hickey RW, O’Connor R, Becker LB, Zaritsky A. Major changes in the 2005 AHA Guidelines for CPR, ECC: reaching the tipping point for change. Circulation 2005;112(24 Suppl):IV206–11.PubMed

Nolan JP, Morley PT, Hoek TL, Hickey RW. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation 2003;57(3):231–5.PubMedCrossRef

10.

Bernard S. Therapeutic hypothermia after cardiac arrest: now a standard of care. Crit Care Med 2006;34(3):923–4.PubMedCrossRef

11.

Bernard SA. Therapeutic hypothermia after cardiac arrest. Hypothermia is now standard care for some types of cardiac arrest. Med J Aust 2004;181(9):468–9.PubMed

12.

Rincon F, Mayer SA. Therapeutic hypothermia for brain injury after cardiac arrest. Semin Neurol 2006;26(4):387–95.PubMedCrossRef

13.

Topjian A, Nadkarni V. Cooling after cardiac arrest: have we reached the tipping point? Crit Care Med 2006;34(7):2017–8.PubMedCrossRef

14.

Merchant RM, Soar J, Skrifvars MB, et al. Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 2006;34(7):1935–40.PubMedCrossRef

15.

Abella BS, Rhee JW, Huang KN, Vanden Hoek TL, Becker LB. Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey. Resuscitation 2005;64(2):181–6.PubMedCrossRef

16.

Sanders AB. Therapeutic hypothermia after cardiac arrest. Curr Opin Crit Care 2006;12(3):213–7.PubMedCrossRef

17.

Zeiner A, Holzer M, Sterz F, et al. Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group. Stroke 2000;31(1):86–94.PubMed

18.

Yanagawa Y, Ishihara S, Norio H, et al. Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest. Resuscitation 1998;39(1–2):61–6.PubMedCrossRef

19.

Moscucci M, Eagle KA. Reducing the door-to-balloon time for myocardial infarction with ST-segment elevation. N Engl J Med 2006;355(22):2364–5.PubMedCrossRef

20.

Grotta JC, Burgin WS, El-Mitwalli A, et al. Intravenous tissue-type plasminogen activator therapy for ischemic stroke: Houston experience 1996 to 2000. Arch Neurol 2001;58(12):2009–13.PubMedCrossRef

21.

Gottesman RF, Alt J, Wityk RJ, Llinas RH. Predicting abnormal coagulation in ischemic stroke: reducing delay in rt-PA use. Neurology 2006;67(9):1665–7.PubMedCrossRef

22.

Felberg RA, Krieger DW, Chuang R, et al. Hypothermia after cardiac arrest: feasibility and safety of an external cooling protocol. Circulation 2001;104(15):1799–804.PubMed

23.

Bernard SA, Jones BM, Horne MK. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med 1997;30(2):146–53.PubMedCrossRef

24.

Hachimi-Idrissi S, Corne L, Ebinger G, Michotte Y, Huyghens L. Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 2001;51(3):275–81.PubMedCrossRef

25.

Callaway CW, Tadler SC, Katz LM, Lipinski CL, Brader E. Feasibility of external cranial cooling during out-of-hospital cardiac arrest. Resuscitation 2002;52(2):159–65.PubMedCrossRef

26.

Bernard S, Buist M, Monteiro O, Smith K. 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.PubMedCrossRef

27.

Xiao F, Safar P, Alexander H. Peritoneal cooling for mild cerebral hypothermia after cardiac arrest in dogs. Resuscitation 1995;30(1):51–9.PubMedCrossRef

28.

Mayer SA, Kowalski RG, Presciutti M, et al. Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med 2004;32(12):2508–15.PubMedCrossRef

29.

Holzer M, Mullner M, Sterz F, et al. Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach. Stroke 2006;37(7):1792–7.PubMedCrossRef

30.

Kliegel A, Losert H, Sterz F, et al. Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest–a feasibility study. Resuscitation 2005;64(3):347–51.PubMedCrossRef

31.

Al-Senani FM, Graffagnino C, Grotta JC, et al. A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGard System and Icy catheter following cardiac arrest. Resuscitation 2004;62(2):143–50.PubMedCrossRef

32.

Merchant RM, Abella BS, Peberdy MA, et al. Therapeutic hypothermia after cardiac arrest: Unintentional overcooling is common using ice packs and conventional cooling blankets. Crit Care Med 2006;34(12 Suppl):S490–4.PubMedCrossRef

33.

Arrich J. Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 2007;35(4):1041–7.PubMedCrossRef

34.

Kuboyama K, Safar P, Radovsky A, Tisherman SA, Stezoski SW, Alexander H. Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study. Crit Care Med 1993;21(9):1348–58.PubMedCrossRef

35.

Nozari A, Safar P, Stezoski SW, et al. Critical time window for intra-arrest cooling with cold saline flush in a dog model of cardiopulmonary resuscitation. Circulation 2006;113(23):2690–6.PubMedCrossRef

Title: Therapeutic Hypothermia after Cardiac Arrest: Performance Characteristics and Safety of Surface Cooling with or without Endovascular Cooling
Authors: Alexander C. Flint
J. Claude Hemphill
David C. Bonovich
Publication date: 01-10-2007
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 2/2007
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-007-0068-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Therapeutic Hypothermia after Cardiac Arrest: Performance Characteristics and Safety of Surface Cooling with or without Endovascular Cooling

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2007

Delayed catastrophic antiphospholipid syndrome after massive cerebral infarction

Neurological complications with acute sphenoid sinusitis a surgical emergency?

Successful Endovascular Treatment of A Ruptured Mycotic Intracavernous Carotid Artery Aneurysm in an AIDS Patient

Levetiracetam use in critically ill patients

Feasibility of IA Thrombolysis for Acute Ischemic Stroke Among Anticoagulated Patients

Determining Intravenous rt-PA Eligibility in the Emergency Department