Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome

Background: Induction of mild hypothermia (MH) in patients resuscitated from cardiac arrest improves their outcome. However, benefits and risks of MH in patients who remain in cardiogenic shock after the return of spontaneous circulation (ROSC) are unclear. We analysed all cardiac arrest survivors w...

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Veröffentlicht in:Acta anaesthesiologica Scandinavica 2008-02, Vol.52 (2), p.188-194
Hauptverfasser: SKULEC, R., KOVARNIK, T., DOSTALOVA, G., KOLAR, J., LINHART, A.
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container_title Acta anaesthesiologica Scandinavica
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creator SKULEC, R.
KOVARNIK, T.
DOSTALOVA, G.
KOLAR, J.
LINHART, A.
description Background: Induction of mild hypothermia (MH) in patients resuscitated from cardiac arrest improves their outcome. However, benefits and risks of MH in patients who remain in cardiogenic shock after the return of spontaneous circulation (ROSC) are unclear. We analysed all cardiac arrest survivors who were treated with MH in our intensive coronary care unit (CCU) and compared the outcome of patients with cardiogenic shock syndrome (CSS) with those who were circulatory stable. Methods: We performed retrospective analysis of all consecutive cardiac arrest survivors treated by MH in our CCU from November 2002 to August 2006. They were classified into two groups, according to whether they met the criteria for cardiogenic shock or not before MH initiation. Results: Out of 56 consecutive patients, 28 fulfilled criteria of cardiogenic shock before MH initiation (group A) and 28 were relatively stable (group B). In‐hospital mortality was 57.1% in group A and 21.4% in group B patients (P=0.013). Favourable neurological outcome anytime during hospitalization was found in 67.9% of group A patients and in 82.1% of group B subjects (P=0.355). Favourable discharge neurological outcome was reached in 39.3% in group A and in 71.4% in group B (P=0.031). The complication rate in both groups did not differ. Conclusion: While in‐hospital mortality in cardiac arrest survivors treated by MH was expectably higher in those with cardiogenic shock than in stable patients, the favourable neurological outcome during hospitalization was comparable in both groups. Therefore, induction of MH should be considered in cardiac arrest survivors with CSS after ROSC.
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However, benefits and risks of MH in patients who remain in cardiogenic shock after the return of spontaneous circulation (ROSC) are unclear. We analysed all cardiac arrest survivors who were treated with MH in our intensive coronary care unit (CCU) and compared the outcome of patients with cardiogenic shock syndrome (CSS) with those who were circulatory stable. Methods: We performed retrospective analysis of all consecutive cardiac arrest survivors treated by MH in our CCU from November 2002 to August 2006. They were classified into two groups, according to whether they met the criteria for cardiogenic shock or not before MH initiation. Results: Out of 56 consecutive patients, 28 fulfilled criteria of cardiogenic shock before MH initiation (group A) and 28 were relatively stable (group B). In‐hospital mortality was 57.1% in group A and 21.4% in group B patients (P=0.013). Favourable neurological outcome anytime during hospitalization was found in 67.9% of group A patients and in 82.1% of group B subjects (P=0.355). Favourable discharge neurological outcome was reached in 39.3% in group A and in 71.4% in group B (P=0.031). The complication rate in both groups did not differ. Conclusion: While in‐hospital mortality in cardiac arrest survivors treated by MH was expectably higher in those with cardiogenic shock than in stable patients, the favourable neurological outcome during hospitalization was comparable in both groups. Therefore, induction of MH should be considered in cardiac arrest survivors with CSS after ROSC.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/j.1399-6576.2007.01510.x</identifier><identifier>PMID: 18005380</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Age Factors ; Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. 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Favourable neurological outcome anytime during hospitalization was found in 67.9% of group A patients and in 82.1% of group B subjects (P=0.355). Favourable discharge neurological outcome was reached in 39.3% in group A and in 71.4% in group B (P=0.031). The complication rate in both groups did not differ. Conclusion: While in‐hospital mortality in cardiac arrest survivors treated by MH was expectably higher in those with cardiogenic shock than in stable patients, the favourable neurological outcome during hospitalization was comparable in both groups. Therefore, induction of MH should be considered in cardiac arrest survivors with CSS after ROSC.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure</topic><topic>Cardiac arrest</topic><topic>cardiogenic shock</topic><topic>Coronary Care Units</topic><topic>Czech Republic</topic><topic>Female</topic><topic>Heart Arrest - complications</topic><topic>Heart Arrest - mortality</topic><topic>Heart Arrest - therapy</topic><topic>Heart Rate</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hypothermia, Induced - adverse effects</topic><topic>Hypothermia, Induced - utilization</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>mild hypothermia</topic><topic>Neurologic Examination</topic><topic>Odds Ratio</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Shock, Cardiogenic - complications</topic><topic>Shock, Cardiogenic - diagnosis</topic><topic>Survival Analysis</topic><topic>Syndrome</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SKULEC, R.</creatorcontrib><creatorcontrib>KOVARNIK, T.</creatorcontrib><creatorcontrib>DOSTALOVA, G.</creatorcontrib><creatorcontrib>KOLAR, J.</creatorcontrib><creatorcontrib>LINHART, A.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SKULEC, R.</au><au>KOVARNIK, T.</au><au>DOSTALOVA, G.</au><au>KOLAR, J.</au><au>LINHART, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2008-02</date><risdate>2008</risdate><volume>52</volume><issue>2</issue><spage>188</spage><epage>194</epage><pages>188-194</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background: Induction of mild hypothermia (MH) in patients resuscitated from cardiac arrest improves their outcome. However, benefits and risks of MH in patients who remain in cardiogenic shock after the return of spontaneous circulation (ROSC) are unclear. We analysed all cardiac arrest survivors who were treated with MH in our intensive coronary care unit (CCU) and compared the outcome of patients with cardiogenic shock syndrome (CSS) with those who were circulatory stable. Methods: We performed retrospective analysis of all consecutive cardiac arrest survivors treated by MH in our CCU from November 2002 to August 2006. They were classified into two groups, according to whether they met the criteria for cardiogenic shock or not before MH initiation. Results: Out of 56 consecutive patients, 28 fulfilled criteria of cardiogenic shock before MH initiation (group A) and 28 were relatively stable (group B). In‐hospital mortality was 57.1% in group A and 21.4% in group B patients (P=0.013). Favourable neurological outcome anytime during hospitalization was found in 67.9% of group A patients and in 82.1% of group B subjects (P=0.355). Favourable discharge neurological outcome was reached in 39.3% in group A and in 71.4% in group B (P=0.031). The complication rate in both groups did not differ. Conclusion: While in‐hospital mortality in cardiac arrest survivors treated by MH was expectably higher in those with cardiogenic shock than in stable patients, the favourable neurological outcome during hospitalization was comparable in both groups. Therefore, induction of MH should be considered in cardiac arrest survivors with CSS after ROSC.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>18005380</pmid><doi>10.1111/j.1399-6576.2007.01510.x</doi><tpages>7</tpages></addata></record>
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subjects Age Factors
Aged
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Pressure
Cardiac arrest
cardiogenic shock
Coronary Care Units
Czech Republic
Female
Heart Arrest - complications
Heart Arrest - mortality
Heart Arrest - therapy
Heart Rate
Hospital Mortality
Humans
Hypothermia, Induced - adverse effects
Hypothermia, Induced - utilization
Male
Medical sciences
Middle Aged
mild hypothermia
Neurologic Examination
Odds Ratio
Outcome and Process Assessment (Health Care)
Retrospective Studies
Risk Assessment
Risk Factors
Shock, Cardiogenic - complications
Shock, Cardiogenic - diagnosis
Survival Analysis
Syndrome
Treatment Outcome
title Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome
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