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Therapeutic hypothermia after cardiac arrest: experience at an academically affiliated community-based veterans affairs medical center.

Shah MP, Zimmerman L, Bullard J, Yenari MA - Stroke Res Treat (2011)

Bottom Line: The majority of cases were in-hospital arrests associated with initial pulseless electrical activity or asystole.Our cooling times and incidence of favorable outcomes are comparable to previously published reports.This study demonstrates the feasibility of implementing, a cooling protocol a community setting, and the role of neurologists in ensuring effective hospital-wide implementation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of California, San Francisco, San Francisco, CA 94121, USA.

ABSTRACT
At laboratory and clinical levels, therapeutic hypothermia has been shown to improve neurologic outcomes and mortality following cardiac arrest. We reviewed each cardiac arrest in our community-based Veterans Affairs Medical Center over a three-year period. The majority of cases were in-hospital arrests associated with initial pulseless electrical activity or asystole. Of a total of 100 patients suffering 118 cardiac arrests, 29 arrests involved comatose survivors, with eight patients completing therapeutic cooling. Cerebral performance category scores at discharge and six months were significantly better in the cooled cohort versus the noncooled cohort, and, in every case except for one, cooling was offered for appropriate reasons. Mean time to initiation of cooling protocol was 3.7 hours and mean time to goal temperature of 33°C was 8.8 hours, and few complications clearly related to cooling were noted in our case series. While in-patient hospital mortality of cardiac arrest was high at 65% mortality during hospital admission, therapeutic hypothermia was safe and feasible at our center. Our cooling times and incidence of favorable outcomes are comparable to previously published reports. This study demonstrates the feasibility of implementing, a cooling protocol a community setting, and the role of neurologists in ensuring effective hospital-wide implementation.

No MeSH data available.


Related in: MedlinePlus

“Code Blue” Alerts at San Francisco VA Medical Center from November 2007 to August 2010. The diagram breaks down the numbers and types of “Code Blue” arrests including brief categorization of reasons of why patients who were comatose after cardiac arrest were not cooled or why cooling was stopped after initiation.
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Related In: Results  -  Collection


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fig1: “Code Blue” Alerts at San Francisco VA Medical Center from November 2007 to August 2010. The diagram breaks down the numbers and types of “Code Blue” arrests including brief categorization of reasons of why patients who were comatose after cardiac arrest were not cooled or why cooling was stopped after initiation.

Mentions: From November 2007 to August 2010, there were 130 “Code Blue” alerts at the San Francisco Veterans Affairs Medical Center (see Figure 1). Of these, 12 of the alarms were done in error or involved cases in which there was no loss of a perfusing cardiac rhythm. Of the remaining 118 alerts involving 100 patients, 38 cardiac arrests occurred in which the patient did not survive. In these cases, the mean age of the patients was 72 years and 97% of the patients were men. Thirty-four arrests were in-hospital (89%) and the initial cardiac rhythm was PEA or asystole in 95% of arrests, with 5% ventricular tachycardia or fibrillation arrests. The mechanism of arrest involved a primary pulmonary arrest in 8 arrests (21%), primary cardiac in 12 (32%), gastrointestinal bleeding or catastrophe in 5 (13%), intraoperative event in 2 (5%), sepsis or infection in 4 (11%), and unknown or other etiology in 7 (18%). Comorbidities within this cohort included coronary artery disease (CAD) or congestive heart failure (CHF) in 17 patients (45%), cardiovascular risk factors defined as hypertension, diabetes, dyslipidemia, or tobacco use disorder in 21 (55%), cancer diagnosis in 9 (24%), pulmonary disease in 8 (21%), gastrointestinal bleeding or end-stage liver disease in 7 (18%), end-stage renal disease in 5 (13%), human immunodeficiency virus (HIV) or hepatitis infection in 2 (5%), and history or ongoing substance or alcohol abuse in 5 (13%).


Therapeutic hypothermia after cardiac arrest: experience at an academically affiliated community-based veterans affairs medical center.

Shah MP, Zimmerman L, Bullard J, Yenari MA - Stroke Res Treat (2011)

“Code Blue” Alerts at San Francisco VA Medical Center from November 2007 to August 2010. The diagram breaks down the numbers and types of “Code Blue” arrests including brief categorization of reasons of why patients who were comatose after cardiac arrest were not cooled or why cooling was stopped after initiation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3140133&req=5

fig1: “Code Blue” Alerts at San Francisco VA Medical Center from November 2007 to August 2010. The diagram breaks down the numbers and types of “Code Blue” arrests including brief categorization of reasons of why patients who were comatose after cardiac arrest were not cooled or why cooling was stopped after initiation.
Mentions: From November 2007 to August 2010, there were 130 “Code Blue” alerts at the San Francisco Veterans Affairs Medical Center (see Figure 1). Of these, 12 of the alarms were done in error or involved cases in which there was no loss of a perfusing cardiac rhythm. Of the remaining 118 alerts involving 100 patients, 38 cardiac arrests occurred in which the patient did not survive. In these cases, the mean age of the patients was 72 years and 97% of the patients were men. Thirty-four arrests were in-hospital (89%) and the initial cardiac rhythm was PEA or asystole in 95% of arrests, with 5% ventricular tachycardia or fibrillation arrests. The mechanism of arrest involved a primary pulmonary arrest in 8 arrests (21%), primary cardiac in 12 (32%), gastrointestinal bleeding or catastrophe in 5 (13%), intraoperative event in 2 (5%), sepsis or infection in 4 (11%), and unknown or other etiology in 7 (18%). Comorbidities within this cohort included coronary artery disease (CAD) or congestive heart failure (CHF) in 17 patients (45%), cardiovascular risk factors defined as hypertension, diabetes, dyslipidemia, or tobacco use disorder in 21 (55%), cancer diagnosis in 9 (24%), pulmonary disease in 8 (21%), gastrointestinal bleeding or end-stage liver disease in 7 (18%), end-stage renal disease in 5 (13%), human immunodeficiency virus (HIV) or hepatitis infection in 2 (5%), and history or ongoing substance or alcohol abuse in 5 (13%).

Bottom Line: The majority of cases were in-hospital arrests associated with initial pulseless electrical activity or asystole.Our cooling times and incidence of favorable outcomes are comparable to previously published reports.This study demonstrates the feasibility of implementing, a cooling protocol a community setting, and the role of neurologists in ensuring effective hospital-wide implementation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of California, San Francisco, San Francisco, CA 94121, USA.

ABSTRACT
At laboratory and clinical levels, therapeutic hypothermia has been shown to improve neurologic outcomes and mortality following cardiac arrest. We reviewed each cardiac arrest in our community-based Veterans Affairs Medical Center over a three-year period. The majority of cases were in-hospital arrests associated with initial pulseless electrical activity or asystole. Of a total of 100 patients suffering 118 cardiac arrests, 29 arrests involved comatose survivors, with eight patients completing therapeutic cooling. Cerebral performance category scores at discharge and six months were significantly better in the cooled cohort versus the noncooled cohort, and, in every case except for one, cooling was offered for appropriate reasons. Mean time to initiation of cooling protocol was 3.7 hours and mean time to goal temperature of 33°C was 8.8 hours, and few complications clearly related to cooling were noted in our case series. While in-patient hospital mortality of cardiac arrest was high at 65% mortality during hospital admission, therapeutic hypothermia was safe and feasible at our center. Our cooling times and incidence of favorable outcomes are comparable to previously published reports. This study demonstrates the feasibility of implementing, a cooling protocol a community setting, and the role of neurologists in ensuring effective hospital-wide implementation.

No MeSH data available.


Related in: MedlinePlus