Cor Vasa 2005, 46(6):235-241
Initial experience with inducing mild hypothermia in cardiac arrest patients
- II. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika
Background:
Cardiac arrest will often result in severe neurological injury. Results of randomized clinical trials showed that induction of mild hypothermia (MH) in patients resuscitated from cardiac arrest to 32-34 °C for 12-24 hours can improve the neurological outcome and even reduce mortality. We have applied this treatment in our Intensive Coronary Care Unit (ICCU) since November 2002; our initial experience is reported below.
Methods:
We performed a retrospective analysis of all patients indicated to therapeutic MH in our ICCU from November 2002 to June 2004. MH was initiated as soon as possible after the return of spontaneous circulation (ROSC) and patients were cooled to a temperature of 32-34 °C for 12 hours.
Results:
A total of 28 patients were indicated to MH treatment. The procedure was initiated in 27 patients. Target temperature was reached in 25 patients. Mean age of all the 25 successfully cooled patients was 66.8 ± 12.1 years; 64% were men. The most frequent reason for cardiac arrest was acute myocardial infarction (56%). The initial rhythm was ventricular fibrillation in 16 patients, pulseless electrical activity in 6 patients, asystole in 1 patient and unknown rhythm in 2 patients. The interval from collapse to the first resuscitation attempt was 3.0 ± 3.2 minutes and that from initiation of resuscitation to ROSC was 14.6 ± 13.6 minutes. Cooling was initiated 31.6 ± 51.1 minutes after ROSC and target temperature below 34 °C was achieved in 228.6 ± 157.4 minutes. Target temperature 32-34 °C persisted for 841.5 ± 157.4 minutes. Mean temperature during this cooling period was 33.1 ± 0.4 °C. In-hospital mortality was 52%, 44% patients were discharged to receive home care and the rest are still hospitalized. A favorable neurological outcome was found in 68% patients. The most frequent complications included hypothermia-induced relative hypovolemia, hypotension, bradycardia and a decrease in cardiac output.
Conclusion:
Therapeutic mild hypothermia in patients resuscitated successfully from cardiac arrest is a safe, simple and effective method for reducing risk of neurological injury and, probably, reducing mortality.
Keywords: Cardiac arrest; Immediate resuscitation; Mild hypothermia
Published: June 1, 2005 Show citation