Temperature Control After Cardiac Arrest: A Narrative Review DOI Creative Commons

Samantha Fernandez Hernandez,

Brooke Barlow, Vera Pertsovskaya

et al.

Advances in Therapy, Journal Year: 2023, Volume and Issue: 40(5), P. 2097 - 2115

Published: March 25, 2023

Cardiac arrest (CA) is a critical public health issue affecting more than half million Americans annually. The main determinant of outcome post-CA hypoxic–ischemic brain injury (HIBI), and temperature control currently the only evidence-based, guideline-recommended intervention targeting secondary injury. Temperature key component care bundle; however, conflicting evidence challenges its wide implementation across vastly heterogeneous population CA survivors. Here, we critically appraise available literature on in HIBI, detail how has been integrated into clinical practice, highlight complications associated with use timing neuroprognostication after CA. Future trials evaluating different targets, rates rewarming, duration cooling, identifying which patient phenotype benefits from methods are needed to address these prevailing knowledge gaps.

Language: Английский

ERC-ESICM guidelines on temperature control after cardiac arrest in adults DOI Open Access
Claudio Sandroni, Jerry P. Nolan, Lars W. Andersen

et al.

Intensive Care Medicine, Journal Year: 2022, Volume and Issue: 48(3), P. 261 - 269

Published: Jan. 28, 2022

Language: Английский

Citations

132
2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care DOI Open Access
Sarah M. Perman, Jonathan Elmer, Carolina B. Maciel

et al.

Circulation, Journal Year: 2023, Volume and Issue: 149(5)

Published: Dec. 18, 2023

Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly used improve outcomes. This "2023 American Heart Association Focused Update on Adult Cardiovascular Life Support" summarizes most recent published evidence for recommendations use of medications, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, seizure management this population. We discuss lack data literature that limits our ability evaluate diversity, equity, inclusion Last, we consider how population may make an important pool organ donors those awaiting transplantation.

Language: Английский

Citations

79
Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial DOI Open Access
Sebastian Wolfrum, Kevin Roedl,

Alexia Hanebutte

et al.

Circulation, Journal Year: 2022, Volume and Issue: 146(18), P. 1357 - 1366

Published: Oct. 19, 2022

Background: This study was conducted to determine the effect of hypothermic temperature control after in-hospital cardiac arrest (IHCA) on mortality and functional outcome as compared with normothermia. Methods: An investigator initiated, open-label, blinded-outcome-assessor, multicenter, randomized controlled trial comparing (32-34°C) for 24 h normothermia IHCA in 11 hospitals Germany. The primary endpoint all-cause 180 days. Secondary end points included favorable using Cerebral Performance Category scale A score 1 or 2 defined a outcome. Results: total 1055 patients were screened eligibility 249 randomized: 126 assigned 123 mean age cohort 72.6±10.4 years, 64% (152 236) male, 73% (166 227) arrests witnessed, 25% (57 231) had an initial shockable rhythm, time return spontaneous circulation 16.4±10.5 minutes. Target reached within 4.2±2.8 hours randomization group 48 at 37.0°±0.9°C group. Mortality by day 72.5% (87 120) arm, 71.2% (84 118) (relative risk, 1.03 [95% CI, 0.79–1.40]; P =0.822). In-hospital 62.5% (75 57.6% (68 1.11 0.86–1.46, =0.443). Favorable (Cerebral 2) 22.5% (27 control, 23.7% (28 1.04 0.78–1.44]; prematurely terminated because futility. Conclusions: Hypothermic did not improve survival nor presenting coma IHCA. HACA (Hypothermia After Cardiac Arrest in-hospital) underpowered may have failed detect clinically important differences between Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT00457431.

Language: Английский

Citations

57
ERC-ESICM guidelines on temperature control after cardiac arrest in adults DOI Creative Commons
Jerry P. Nolan, Claudio Sandroni, Lars W. Andersen

et al.

Resuscitation, Journal Year: 2022, Volume and Issue: 172, P. 229 - 236

Published: Feb. 4, 2022

The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless the underlying rhythm. These replace recommendations on management arrest included 2021 post-resuscitation care co-issued by European Resuscitation Council (ERC) and Society Intensive Care Medicine (ESICM).The guideline panel thirteen international clinical experts authored ERC-ESICM two methodologists participated evidence review completed behalf International Liaison Committee (ILCOR) whom ERC a member society. We followed Grading Recommendations Assessment, Development, Evaluation (GRADE) approach assess certainty grade recommendations. provided suggestions implementation identified priorities future research.The ranged moderate low. In patients remain we recommend continuous monitoring core actively preventing fever (defined as > 37.7 °C) at least 72 hours. There was insufficient against 32–36 °C early cooling arrest. not rewarming with mild hypothermia return spontaneous circulation (ROSC) achieve normothermia. using prehospital rapid infusion large volumes cold intravenous fluids immediately ROSC.

Language: Английский

Citations

54
Hypothermia for neuroprotection in adults after cardiac arrest DOI
Jasmin Arrich,

Nikola Schütz,

Julia Oppenauer

et al.

Cochrane library, Journal Year: 2023, Volume and Issue: 2023(6)

Published: May 22, 2023

Language: Английский

Citations

35
Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care DOI Open Access
Sean van Diepen,

Michel R. Le May,

Patricia Alfaro

et al.

Canadian Journal of Cardiology, Journal Year: 2024, Volume and Issue: 40(4), P. 524 - 539

Published: April 1, 2024

Language: Английский

Citations

10
Improving Outcomes After Post–Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation DOI
Gavin D. Perkins, Robert W. Neumar, Cindy H. Hsu

et al.

Circulation, Journal Year: 2024, Volume and Issue: 150(7)

Published: June 27, 2024

This scientific statement presents a conceptual framework for the pathophysiology of post–cardiac arrest brain injury, explores reasons previous failure to translate preclinical data clinical practice, and outlines potential paths forward. Post–cardiac injury is characterized by 4 distinct but overlapping phases: ischemic depolarization, reperfusion repolarization, dysregulation, recovery repair. Previous research has been challenging because limitations laboratory models; heterogeneity in patient populations enrolled; overoptimistic estimation treatment effects leading suboptimal sample sizes; timing route intervention delivery; limited or absent evidence that engaged mechanistic target; postresuscitation care, prognostication, withdrawal life-sustaining treatments. Future trials must tailor their interventions subset patients most likely benefit deliver this at appropriate time, through route, dose. The complexity suggests monotherapies are unlikely be as successful multimodal neuroprotective therapies. Biomarkers should developed identify with targeted mechanism quantify its severity, measure response therapy. Studies need adequately powered detect effect sizes realistic meaningful patients, families, clinicians. Study designs optimized accelerate evaluation promising interventions. Multidisciplinary international collaboration will essential realize goal developing effective therapies injury.

Language: Английский

Citations

9
Temperature control after adult cardiac arrest: An updated systematic review and meta-analysis DOI Creative Commons
Asger Granfeldt, Mathias J. Holmberg, Jerry P. Nolan

et al.

Resuscitation, Journal Year: 2023, Volume and Issue: 191, P. 109928 - 109928

Published: Aug. 7, 2023

To perform an updated systematic review and meta-analysis on temperature control in adult patients with cardiac arrest.The is update of a previous published 2021. An search including PubMed, Embase, the Cochrane Central Register Controlled Trials was performed May 31, 2023. trials humans were included. The population included arrest. all aspects timing, temperature, duration, method induction maintenance, rewarming. Two investigators reviewed for relevance, extracted data, assessed risk bias. Data pooled using random-effects models. Certainty evidence evaluated GRADE.The identified six new trials. Risk bias as intermediate most outcomes. For target 32-34 °C vs. normothermia or 36 °C, two identified, seven meta-analysis. Temperature did not result improvement survival (risk ratio: 1.06 [95%CI: 0.91, 1.23]) favorable neurological outcome 1.27 0.89, 1.81]) at 90-180 days after arrest (low certainty evidence). Subgroup analysis according to location (in-hospital out-of-hospital) found similar results. A sensitivity nine comparing any time point also show outcomes 1.14 [95%CI 0.98, 1.34]). New individual 31-34 12-24 hours hours, rewarming rate 0.25-0.5 °C/hour, effect fever prevention no differences outcomes.This showed benefit compared although 95% confidence intervals cannot rule out potential beneficial effect. Important knowledge gaps exist topics such hypothermic targets, rate, control.

Language: Английский

Citations

20
Temperature control after cardiac arrest DOI Creative Commons
Claudio Sandroni, Daniele Natalini, Jerry P. Nolan

et al.

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Nov. 24, 2022

Abstract Most of the patients who die after cardiac arrest do so because hypoxic-ischemic brain injury (HIBI). Experimental evidence shows that temperature control targeted at hypothermia mitigates HIBI. In 2002, one randomized trial and quasi-randomized showed 32–34 °C improved neurological outcome mortality in are comatose arrest. However, following publication these trials, other studies have questioned neuroprotective effects hypothermia. 2021, largest study conducted far on (the TTM-2 trial) including 1900 adults resuscitation no effect 33 compared with normothermia or fever control. A systematic review 32 trials published between 2001 2021 concluded a target prevention did not result an improvement survival (RR 1.08; 95% CI 0.89–1.30) favorable functional 1.21; 0.91–1.61) 90–180 days resuscitation. There was substantial heterogeneity across certainty low. Based results, International Liaison Committee Resuscitation currently recommends monitoring core actively preventing (37.7 °C) for least 72 h from Future needed to identify potential patient subgroups may benefit aimed comparing

Language: Английский

Citations

25
Contemporary Management of Concomitant Cardiac Arrest and Cardiogenic Shock Complicating Myocardial Infarction DOI Open Access
Saraschandra Vallabhajosyula, Dhiran Verghese, Timothy D. Henry

et al.

Mayo Clinic Proceedings, Journal Year: 2022, Volume and Issue: 97(12), P. 2333 - 2354

Published: Dec. 1, 2022

Language: Английский

Citations

24