Notfall + Rettungsmedizin, Год журнала: 2023, Номер unknown
Опубликована: Дек. 5, 2023
Resuscitation, Год журнала: 2024, Номер unknown, С. 110414 - 110414
Опубликована: Ноя. 1, 2024
Язык: Английский
Процитировано
11
Journal of the American Heart Association, Год журнала: 2025, Номер unknown
Опубликована: Янв. 14, 2025
Язык: Английский
Процитировано
0
World Journal of Emergency Medicine, Год журнала: 2025, Номер 16(1), С. 3 - 3
Опубликована: Янв. 1, 2025
Язык: Английский
Процитировано
0
European Journal of Anaesthesiology, Год журнала: 2023, Номер 41(4), С. 278 - 281
Опубликована: Дек. 19, 2023
Background Out-of-hospital cardiac arrest (OHCA) is the third leading cause of death in Europe, and results a high burden disability for patients their families.1 When heart stops, body brain cells quickly deplete oxygen. Without intervention, damage occurs rapidly, inevitable. Unfortunately, prognosis OHCA remains poor, even when return spontaneous circulation (ROSC) achieved. Only few (less than 10%) can be discharged from hospital, only two thirds these are with good neurological outcome to lead an independent life.1 Reperfusion injury starts immediately following ROSC. Multiple pathophysiological cascades reactive astrogliosis microglia activation, neuronal by necrosis apoptosis. This one key components what has been described as 'post resuscitation syndrome'.2 Mild hypothermia range 32 34 °C was shown mitigate different simultaneously, efficiently limiting cell damage.3 Numerous animal studies confirmed beneficial effect mild hypothermia.4 In 2002, landmark randomised clinical trials (RCT) after shockable rhythm showed improved outcomes treatment compared no temperature control.5,6 As result studies, 2005, European Resuscitation Council (ERC) guidelines recommended use 24 h unconscious adults resuscitated out-of-hospital rhythm; nonshockable in-hospital arrest, control suggested weak recommendation.7 One criticism original that groups studies5,6 not strictly normothermic but slightly hyperthermic, around 37 38 °C. prompted prospective trial comparing strict at 36 33 (the targeted management TTM1 trial).8 published 2013 difference mortality between study groups. Consequently, ERC 2015 2021 extended post target wider °C.9,10 2019, RCT normothermia °C.11 2021, further TTM2 early fever (body ≥37.8 °C).12 same year, meta-analysis published, concluding TTM 34°C, normothermia, did outcomes.13 latest co-operation Society Intensive Care Medicine (ESICM) preventing amended recommendation there insufficient evidence recommend or against some subgroups may benefit such control.14 Critical appraisal current 2022 Council/European new scientific There number important limitations large studies8,12 have greatly affected over last years. Firstly, rate bystander cardiopulmonary all 73 82%, which considerably higher average Europe 58%.1 Observational data comparative analysis show short time, it case CPR, presumably less so might hypothermia, increases longer duration arrest.15,16 Secondly, both allowed delay up 3 4 ROSC randomisation, taken 7 achieve. injury, however, pathophysiology shows earlier cooling more effective. previous showing initiated ambulance service6 median 105 min.5 Thirdly, included many centres various countries, each centre enrolling patients. creates potential considerable heterogeneity other aspects postresuscitation care. For this reason, possible dose–response detected level heterogeneity. The recommendations on ERC/ESICM14 predominantly based Granfeld et al.13 meta-analysis,13 selected were separated into analyses. reporting discharge 30 days, 6 months. Both meta-analyses risk ratio favour normothermia; 95% confidence interval crossed 1, group analyses considered statistically significant. Splitting evaluation time points reduced eligible subsequently overall power meta-analysis, ability demonstrate positive effect. summarising available underlying question. Why split underpowered clear. addition, previously proportion good/poor does change time,17 thus splitting required performing provide results. A retrospective demonstrated subgroup suspected moderate benefited most therapy These specifically patient lower basic life support,15 no-flow duration,16 intermediate ROSC,18 lactate levels arrival,19 classification,20,21 EEG pattern suggesting encephalopathy.22 total, represent 40% All make sense, neuroprotective too mild, or, side range, severe. Cochrane systematic review recently published.23 Due methodology, standardisation transparency, highest quality.24 represents recent complete includes 12 trials. authors found, conventional methods induce therapeutic 34°C associated arrest.23 seemed nonwitnessed CPR rates 60%, times 1 min, within 2 ROSC.23 released submitted editorial process.25 However, stated pending formal assessment, seems including study26 would changed main conclusion.23 Another confirms hypothermia.27 After publication very review, another update served basis ERC/ESICM guidelines.28 concluded updated °C, although intervals cannot rule out effect.28 complete, four additional RCTs mentioned above. Summary 2023 (1) Animal models remarkable induced (2) Some significant though controlled do confirm Which (32 °C) temperatures still unknown. (3) Earlier nonsignificant arrest. comprehensive RCT, (4) Several indicate especially presumed damage. (5) human worse control. Recommendation uncertainty exists whether terms improving ESICM merely prevent fever, our view, neither take account evidence, nor consider shortcomings studies. Based significantly along fact deleterious outcome, we suggest international follow interim period, clinicians should soon feasible, maintain least h. Active (36.5 37.7 ensured rewarming before during avoid fever. Future needed identify who find optimal point initiating hypothermia.
Язык: Английский
Процитировано
8
European Journal of Emergency Medicine, Год журнала: 2023, Номер 31(2), С. 86 - 89
Опубликована: Дек. 21, 2023
Background Out-of-hospital cardiac arrest (OHCA) is the third leading cause of death in Europe, with a high burden disability for patients and their families [1]. When heart stops, body brain cells quickly deplete oxygen. Without intervention, damage occurs rapidly, inevitable. Unfortunately, prognosis OHCA remains poor, even when return spontaneous circulation (ROSC) achieved. Only few (less than 10%) can be discharged from hospital, only two-thirds these are good neurologic outcome to lead an independent life Reperfusion injury starts immediately following ROSC. Multiple pathophysiologic cascades reactive astrogliosis microglia activation neuronal by necrosis apoptosis. This one key component what has been described as 'post-resuscitation syndrome' [2]. Mild hypothermia temperature range 32 34°C was shown mitigate different simultaneously, efficiently limiting cell [3]. Numerous animal studies confirmed beneficial effect mild [4]. In 2002, two landmark randomized clinical trials (RCT) after shockable rhythm showed improved neurological outcomes treatment compared no control [5,6]. As result studies, 2005, European Resuscitation Council (ERC) guidelines recommended use 24 h unconscious adults resuscitated out-of-hospital rhythm; non-shockable in-hospital arrest, suggested weak recommendation [7]. One criticism original that groups [5,6] not strictly normothermic but slightly hyperthermic, around 37 38°C. prompted prospective trial comparing strict at 36°C 33°C (the targeted management TTM1 trial) [8]. published 2013 difference mortality between study groups. Consequently, ERC 2015 2021 extended post resuscitation target wider [9,10]. 2019, RCT normothermia 37°C [11]. 2021, further TTM2 early fever (body ≥37.8°C) [12]. same year, meta-analysis published, concluding TTM 34°C, normothermia, did [13]. latest cooperation Society Intensive Care Medicine (ESICM) preventing amended there insufficient evidence recommend or against 36°C, some subgroups may benefit such [14]. Critical appraisal current 2022 ERC/ESICM new scientific There number important limitations large [8,12], have greatly affected over last years. Firstly, rate bystander cardiopulmonary all 73 82%, which considerably higher average Europe 58% Observational data comparative analysis show short time, it case CPR, presumably less so might hypothermia, increases longer duration [15,16]. Secondly, both allowed delay up three four hours ROSC randomization, taken 7 achieve. injury, however, pathophysiology shows earlier cooling more effective. previous showing initiated ambulance service [6] median 105 min [5]. Thirdly, included many centers various countries, each center enrolling patients. creates potential considerable heterogeneity other aspects post-resuscitation care. For this reason, possible dose-response detected level heterogeneity. The recommendations on [14] predominantly based Granfeld et al. [13] [13], selected were separated into analyses. reporting discharge 30 days, 3 months 6 months. Both meta-analyses risk ratio favor 95% confidence interval crossed 1, results group analyses considered statistically significant. Splitting evaluation time points reduced eligible subsequently overall power meta-analysis, ability demonstrate positive effect. summarizing available underlying question. Why split underpowered clear. addition, previously shown, proportion good/poor does change [17], thus splitting required, performing provide results. A retrospective demonstrated subgroup suspected moderate benefited most therapy 34°C. These specifically patient lower basic support [15], no-flow [16], intermediate [18], lactate levels arrival [19], classification [20,21], EEG pattern suggesting encephalopathy [22]. total, represent 40% All make pathophysiological sense, since neuroprotective too mild, or, side range, severe. Cochrane systematic review recently [23]. Due methodology, standardization, transparency, highest quality [24]. represents recent complete includes 12 trials. authors found, conventional methods induce therapeutic associated seemed non-witnessed CPR rates 60%, times minute, within released Cochran submitted editorial process [25]. However, stated pending formal assessment, seems including [26] would changed main conclusion Another confirms [27]. After publication very review, another update served basis [28]. concluded updated although intervals cannot rule out additional RCTs, mentioned above. Summary 2023 Animal models remarkable induced Some significant though controlled do confirm Which (32 34°C) temperatures still unknown. Earlier non-significant 34° arrest. comprehensive RCT, Several indicate especially presumable damage. human worse outcome. Recommendation uncertainty exists whether terms improving ESICM merely prevent fever, our view, neither take account evidence, nor consider shortcomings studies. Based significantly along fact deleterious outcome, we suggest international follow interim period clinicians should adult soon feasible, maintain least h. Active (36.5 37.7°C) ensured rewarming before during neuroprognostication avoid fever. Future needed identify who find optimal point initiating hypothermia. Acknowledgements Conflicts interest Wilhelm Behringer: Speakers honoraria Zoll Medical Corporation Becton Dickinson GmbH. Bernd W. Böttiger: fees Forum für medizinische Fortbildung (FomF), Baxalta Deutschland GmbH, ZOLL C.R. Bard GS Elektromedizinische Geräte G. Stemple Novartis Pharma Philips GmbH Market DACH, Bioscience Valuation BSV Fundacja Polski Instytut Evidence Medicine. Daniele Biasucci: Honoraria Vygon SAS having written educational materials website. Jim Connolly: Educational Sonosite; ultrasound machine placement Terrason, Cannon, Echonous; Personal shares Smith & Nephew, GSK, Inovio, Linde, any conflicts related topic manuscript. Abdo Khoury: Corporation, Archeon Medical, Aguettant, Vygon, Baxter, Fisher Paykel, Giuseppe Ristagno: Participated advisory board Healthcare remaining authors, interest.
Язык: Английский
Процитировано
8
European Journal of Anaesthesiology, Год журнала: 2024, Номер 41(7), С. 468 - 472
Опубликована: Июнь 7, 2024
Язык: Английский
Процитировано
2
Critical Care Explorations, Год журнала: 2024, Номер 6(7), С. e1104 - e1104
Опубликована: Июль 1, 2024
IMPORTANCE: Ventilator-associated pneumonia (VAP) frequently occurs in patients with cardiac arrest. Diagnosis of VAP after arrest remains challenging, while the use current biomarkers such as C-reactive protein (CRP) or procalcitonin (PCT) is debated. OBJECTIVES: To evaluate biomarkers’ impact helping diagnosis DESIGN, SETTING, AND PARTICIPANTS: This a prospective ancillary study randomized, multicenter, double-blind placebo-controlled ANtibiotherapy during Therapeutic HypothermiA to pRevenT Infectious Complications (ANTHARTIC) trial evaluating antibiotic prophylaxis prevent out-of-hospital secondary shockable rhythm and treated therapeutic hypothermia. An adjudication committee blindly evaluated according predefined clinical, radiologic, microbiological criteria. All available biomarker(s), sample(s), consent approval were included. MAIN OUTCOMES MEASURES: The main endpoint was ability correctly diagnose predict within 48 hours sampling. combination two discriminating VAP. Blood samples collected at baseline on day 3. Routine exploratory panel inflammatory measurements performed. Analyses adjusted randomization group. RESULTS: Among 161 ANTHARTIC biological ( n = 33) had higher body mass index Acute Physiology Chronic Health Evaluation II score, more unwitnessed arrest, catecholamines, experienced prolonged hypothermia duration than without 121). In univariate analyses, significantly associated showing an area under curve (AUC) greater 0.70 CRP (AUC 0.76), interleukin (IL) 17A 17C (IL17C) (0.74), macrophage colony-stimulating factor 1 (0.73), PCT (0.72), vascular endothelial growth A (VEGF-A) (0.71). Multivariate analysis combining novel revealed several pairs p value less 0.001 odds ratio 1: VEGF-A + IL12 subunit beta (IL12B), Fms-related tyrosine kinase 3 ligands (Flt3L) C–C chemokine 20 (CCL20), Flt3L IL17A, IL6, STAM-binding (STAMBP) CCL20, STAMBP CCL20 4EBP1, caspase-8 (CASP8), IL6 CASP8. Best AUCs observed for (0.79), (0.78), IL17C. CONCLUSIONS RELEVANCE: Our shows that specific biomarkers, especially combined could help better early occurrence patients.
Язык: Английский
Процитировано
1
Journal of Cerebral Blood Flow & Metabolism, Год журнала: 2024, Номер unknown
Опубликована: Сен. 9, 2024
Extracorporeal cardiopulmonary resuscitation (ECPR) facilitates with immediate and precise temperature control. This study aimed to determine the optimal reperfusion minimize neurological damage after ventricular fibrillation cardiac arrest (VFCA). Twenty-four rats were randomized (n = 8 per group) normothermia (NT 37°C), mild hypothermia (MH 33°C) or moderate (MOD 27°C). The subjected 10 minutes of VFCA, before 15 ECPR at their respective target temperature. After weaning, in MOD group rapidly rewarmed 33°C, maintained 33°C (MH/MOD) 37°C (NT) for 12 hours slow rewarming (MH/MOD). primary outcome was 30-day survival overall performance category (OPC) 1 2 (1 normal, slight disability, 3 severe 4 comatose, 5 dead). Secondary outcomes included awakening rate (OPC ≤ 3) deficit score (NDS, from 0 normal 100 brain did not differ between temperatures 25%, MH 63%, 38%, p 0.301). had lowest NDS 4[IQR 3-4], 2[1-2], 5[3-5], 0.044) highest 88%, 75%, 0.024). In conclusion, statistically significantly improve VFCA when compared 27°C but neuroprotective as measured by function.
Язык: Английский
Процитировано
1
Current Opinion in Critical Care, Год журнала: 2024, Номер unknown
Опубликована: Окт. 21, 2024
Purpose of review Following successful resuscitation from cardiac arrest, a complex set pathophysiologic processes are acutely triggered, leading to substantial morbidity and mortality. Postarrest management remains major challenge critical care providers, with few proven therapeutic strategies improve outcomes. One therapy that has received focus is the intentional lowering core body temperature for discrete period time following resuscitation. In this review, we will discuss key trials other evidence surrounding TTM present opposing arguments, one ‘against’ use postarrest another ‘for’ approach. Recent findings Targeted management, been topic enormous controversy, as recently number clinical show conflicting results on effect TTM. Fundamental questions, about dosing (e.g. at 33 °C versus higher temperatures), or all (as opposed passive fever avoidance), remain active topics global discussion. Systematic reviews also variable results. Summary There several arguments against targeting alleviating brain injury after arrest. More studies way hopefully provide more robust allow consensus important topic.
Язык: Английский
Процитировано
1
Resuscitation, Год журнала: 2023, Номер 194, С. 110052 - 110052
Опубликована: Ноя. 22, 2023
The authors regret, that during their work creating Consensus on Science with Treatment Recommendations (CoSTRs) for ILCOR they discovered three data errors. This corrigendum addresses these errors in the article. would like to apologise any inconvenience caused. 1) In eTable 4 and abstract, we have reported odds ratio from meta-analysis instead of risk favorable neurological outcome at 90 or 180 days. correction this error changes estimate an 1.27 (95% CI: 0.89 1.81) a 1.16 0.92 1.47). overall conclusion manuscript was not affected by error. 2) 5, pooled days based random effects analysis intended fixed effect analysis, as corresponding eFigure 9. 1.22 0.61 2.45) 1.01 0.88 1.15). updated certainty evidence very low due less serious imprecision. 3) 8 supplemental content, 130 total events study Wolfrum it should been 120 events.2 number 1.14 [95% 0.75 1.72]) (Fig. 1.21 0.80 1.83]) 2). further null but did change significance result. isolated mentioned figure does affect original manuscript.Tabled 1eTable 4. GRADE temperature control 32-34°C vs normothermiaCertainty assessmentNo. patientsEffectCertaintyImportanceTrialsStudy designRisk biasInconsistencyIndirectnessImprecisionOther considerationsTemperature 32-34°CNormo-thermiaRelative CI)Absolute CI)Survival hospital discharge63-8randomized trialsserious anot bnot seriousserious cnone707/1536 (46.0%)703/1538 (45.7%)RR 1.07 (0.91 1.25)32 more per 1,000 (from 41 fewer 114 more)⊕⊕○○LOWCRITICALFavorable discharge 30 days43,4,7,8randomized dnone439/1198 (36.6%)434/1179 (36.8%)RR 1.16(0.81 1.66)59 1,000(from 70 243 more)⊕⊕○○LOWCRITICALSurvival days64-9randomized seriousSeriouscnone642/1502 (42.7%)640/1512 (42.3%)RR 1.06(0.91 1.23)25 38 97 dnone567/1494 (38.0%)529/1497 (35.3%)RR 1.16(0.92 1.47)57 28 166 more)⊕⊕○○LOWCRITICAL Open table new tab Confidence interval, RR: ratio.Fig. 2New 8. Temperature normothermia – In-hospital cardiac arrest. Outcome according setting. TC refers control.View Large Image Figure ViewerDownload Hi-res image Download (PPT) aAll trials were assessed having intermediate bias. bAlthough there some inconsistencies between trials, decided downgrade since inconsistency indirectly accounted width confidence interval subsequent downgrading cConfidence include both no potential benefit. dConfidence benefit harm.Tabled 5. 33°C 36°CCertainty considerations33°C36°CRelative(95% CI)Absolute(95% CI)Favorable discharge110randomized trialserious seriousnot bnone207/473 (43.8%)212/465 (45.6%)RR 0.96(0.83 1.11)18 78 50 days210,11randomized seriouscnot seriousseriousbnone233/498 (46.8%)229/492 (46.5%)RR 1.01(0.88 1.15)4 42 53 days110randomized bnone247/473 (52.2%)246/466 (52.8%)RR 0.99(0.88 1.12)5 63 ratio. aThe included trial bConfidence harm. cAlthough dVery wide 1Granfeldt A. Holmberg M.J. Nolan J.P. Soar J. Andersen L.W. International Liaison Committee Resuscitation IALSTF after adult arrest: systematic review meta-analysis.Resuscitation. 2023; 191: 109928https://doi.org/10.1016/j.resuscitation.2023.109928Google Scholar, 2Wolfrum S. Roedl K. Hanebutte et al.Temperature in-hospital randomized clinical trial.Circulation. 2022; 146: 1357-1366https://doi.org/10.1161/circulationaha.122.060106Google 3Bernard S.A. Gray T.W. Buist M.D. al.Treatment comatose survivors out-of-hospital arrest induced hypothermia.N Engl J Med. 2002; 346 (346/8/557 [pii]): 557-563https://doi.org/10.1056/NEJMoa003289Google 4Hypothermia Cardiac Arrest Study Group Mild therapeutic hypothermia improve neurologic arrest.N 346: 549-556https://doi.org/10.1056/NEJMoa012689Google 5Lascarrou J.B. Merdji H. Le Gouge al.Targeted management nonshockable rhythm.N 2019; 381: 2327-2337https://doi.org/10.1056/NEJMoa1906661Google 6Laurent I. Adrie C. Vinsonneau al.High-volume hemofiltration study.J Am Coll Cardiol. 2005; 46: 432-437https://doi.org/10.1016/j.jacc.2005.04.039Google 7Dankiewicz Cronberg T. Lilja G. al.Hypothermia versus 2021; 384: 2283-2294https://doi.org/10.1056/NEJMoa2100591Google 8Hachimi-Idrissi Zizi M. Nguyen D.N. al.The evolution serum astroglial S-100 beta protein patients treated mild hypothermia.Resuscitation. 64: 187-192https://doi.org/10.1016/j.resuscitation.2004.08.008Google Scholar. An meta-analysisResuscitationVol. 191PreviewTo perform Full-Text PDF Access
Язык: Английский
Процитировано
2