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Hypothermia and neurologic outcome in patients following cardiac arrest: should we be hot to cool off our patients?

Smith TL, Bleck TP - Crit Care (2002)

Bottom Line: Hypothermia as a protectant of neurologic function in the treatment of cardiac arrest patients, although not a new concept, is now supported by two recent randomized, prospective clinical trials.The basic science research in support of the effects of hypothermia at the cellular and animal levels is extensive.The process of cooling for cerebral protection holds potential promise for human resuscitation efforts in multiple realms.

View Article: PubMed Central - PubMed

Affiliation: Neuroscience Critical Care, and Clinical Instructor of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA. tls2u@virginia.edu

ABSTRACT
Hypothermia as a protectant of neurologic function in the treatment of cardiac arrest patients, although not a new concept, is now supported by two recent randomized, prospective clinical trials. The basic science research in support of the effects of hypothermia at the cellular and animal levels is extensive. The process of cooling for cerebral protection holds potential promise for human resuscitation efforts in multiple realms. It appears that, at least, those patients who suffer a witnessed cardiac arrest with ventricular fibrillation and early restoration of spontaneous circulation, such as those who were included in the European and Australian trials (discussed here), should be considered for hypothermic therapy.

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Difference in hypothermia versus normothermia: study comparisons. Shown is the percentage favorable outcome, or survival to discharge, compared among the two recent studies of hypothermia as treatment following cardiac arrest [1,2], a small series from 1959 (27 patients, 12 treated with hypothermia) [9], and three nonhypothermic series [20,21,22]. The right-most three bars are zero within the hypothermia group because they represent studies that were not designed to test hypothermia as an intervention [20,21,22]. Visual comparison reveals the closeness of new data from the two trials [1,2] with respect to the other studies [9,20,21,22]. *, †, ‡These studies were not hypothermic trials; rather, they are included here to give a perspective on relative discharge statistics following cardiac arrest from other series.
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Figure 1: Difference in hypothermia versus normothermia: study comparisons. Shown is the percentage favorable outcome, or survival to discharge, compared among the two recent studies of hypothermia as treatment following cardiac arrest [1,2], a small series from 1959 (27 patients, 12 treated with hypothermia) [9], and three nonhypothermic series [20,21,22]. The right-most three bars are zero within the hypothermia group because they represent studies that were not designed to test hypothermia as an intervention [20,21,22]. Visual comparison reveals the closeness of new data from the two trials [1,2] with respect to the other studies [9,20,21,22]. *, †, ‡These studies were not hypothermic trials; rather, they are included here to give a perspective on relative discharge statistics following cardiac arrest from other series.

Mentions: Despite the study flaws described above, outcomes show agreement with the relative percentages presented in other studies. In Fig. 1 the numbers of favorable outcomes from the normothermia arms of the two trials can be seen to approximate closely those of other studies over time. Also, despite the small size of the samples, both studies achieved statistical significance (Table 1).


Hypothermia and neurologic outcome in patients following cardiac arrest: should we be hot to cool off our patients?

Smith TL, Bleck TP - Crit Care (2002)

Difference in hypothermia versus normothermia: study comparisons. Shown is the percentage favorable outcome, or survival to discharge, compared among the two recent studies of hypothermia as treatment following cardiac arrest [1,2], a small series from 1959 (27 patients, 12 treated with hypothermia) [9], and three nonhypothermic series [20,21,22]. The right-most three bars are zero within the hypothermia group because they represent studies that were not designed to test hypothermia as an intervention [20,21,22]. Visual comparison reveals the closeness of new data from the two trials [1,2] with respect to the other studies [9,20,21,22]. *, †, ‡These studies were not hypothermic trials; rather, they are included here to give a perspective on relative discharge statistics following cardiac arrest from other series.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC137323&req=5

Figure 1: Difference in hypothermia versus normothermia: study comparisons. Shown is the percentage favorable outcome, or survival to discharge, compared among the two recent studies of hypothermia as treatment following cardiac arrest [1,2], a small series from 1959 (27 patients, 12 treated with hypothermia) [9], and three nonhypothermic series [20,21,22]. The right-most three bars are zero within the hypothermia group because they represent studies that were not designed to test hypothermia as an intervention [20,21,22]. Visual comparison reveals the closeness of new data from the two trials [1,2] with respect to the other studies [9,20,21,22]. *, †, ‡These studies were not hypothermic trials; rather, they are included here to give a perspective on relative discharge statistics following cardiac arrest from other series.
Mentions: Despite the study flaws described above, outcomes show agreement with the relative percentages presented in other studies. In Fig. 1 the numbers of favorable outcomes from the normothermia arms of the two trials can be seen to approximate closely those of other studies over time. Also, despite the small size of the samples, both studies achieved statistical significance (Table 1).

Bottom Line: Hypothermia as a protectant of neurologic function in the treatment of cardiac arrest patients, although not a new concept, is now supported by two recent randomized, prospective clinical trials.The basic science research in support of the effects of hypothermia at the cellular and animal levels is extensive.The process of cooling for cerebral protection holds potential promise for human resuscitation efforts in multiple realms.

View Article: PubMed Central - PubMed

Affiliation: Neuroscience Critical Care, and Clinical Instructor of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA. tls2u@virginia.edu

ABSTRACT
Hypothermia as a protectant of neurologic function in the treatment of cardiac arrest patients, although not a new concept, is now supported by two recent randomized, prospective clinical trials. The basic science research in support of the effects of hypothermia at the cellular and animal levels is extensive. The process of cooling for cerebral protection holds potential promise for human resuscitation efforts in multiple realms. It appears that, at least, those patients who suffer a witnessed cardiac arrest with ventricular fibrillation and early restoration of spontaneous circulation, such as those who were included in the European and Australian trials (discussed here), should be considered for hypothermic therapy.

Show MeSH
Related in: MedlinePlus