Time to Cooling Is Associated with Resuscitation Outcomes

Autor: Nathan Deal, Sarathi Kalra, Andreas Janata, Fritz Sterz, Robert B. Schock, W. Frank Peacock
Rok vydání: 2016
Předmět:
Resuscitation
medicine.medical_specialty
Time Factors
cooling strategies
medicine.medical_treatment
temperature mechanisms
cardiac arrest
030204 cardiovascular system & hematology
Targeted temperature management
Return of spontaneous circulation
Critical Care and Intensive Care Medicine
Ventricular tachycardia
Time-to-Treatment
law.invention
03 medical and health sciences
0302 clinical medicine
Hypothermia
Induced
Risk Factors
law
Cardiopulmonary bypass
Animals
Humans
Medicine
postresuscitation cooling
human studies
business.industry
030208 emergency & critical care medicine
Original Articles
Recovery of Function
Hypothermia
medicine.disease
Heart Arrest
3. Good health
Surgery
Treatment Outcome
Anesthesiology and Pain Medicine
Cooling rate
Anesthesia
Ventricular fibrillation
Linear Models
medicine.symptom
business
Body Temperature Regulation
Zdroj: Therapeutic Hypothermia and Temperature Management
ISSN: 2153-7933
2153-7658
Popis: Our purpose was to analyze evidence related to timing of cooling from studies of targeted temperature management (TTM) after return of spontaneous circulation (ROSC) after cardiac arrest and to recommend directions for future therapy optimization. We conducted a preliminary review of studies of both animals and patients treated with post-ROSC TTM and hypothesized that a more rapid cooling strategy in the absence of volume-adding cold infusions would provide improved outcomes in comparison with slower cooling. We defined rapid cooling as the achievement of 34°C within 3.5 hours of ROSC without the use of volume-adding cold infusions, with a ≥3.0°C/hour rate of cooling. Using the PubMed database and a previously published systematic review, we identified clinical studies published from 2002 through 2014 related to TTM. Analysis included studies with time from collapse to ROSC of 20-30 minutes, reporting of time from ROSC to target temperature and rate of patients in ventricular tachycardia or ventricular fibrillation, and hypothermia maintained for 20-24 hours. The use of cardiopulmonary bypass as a cooling method was an exclusion criterion for this analysis. We compared all rapid cooling studies with all slower cooling studies of ≥100 patients. Eleven studies were initially identified for analysis, comprising 4091 patients. Two additional studies totaling 609 patients were added based on availability of unpublished data, bringing the total to 13 studies of 4700 patients. Outcomes for patients, dichotomized into faster and slower cooling approaches, were determined using weighted linear regression using IBM SPSS Statistics software. Rapid cooling without volume-adding cold infusions yielded a higher rate of good neurological recovery than slower cooling methods. Attainment of a temperature below 34°C within 3.5 hours of ROSC and using a cooling rate of more than 3°C/hour appear to be beneficial.
Databáze: OpenAIRE
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