Therapeutic hypothermia after cardiac arrest: Unintentional overcooling is common using ice packs and conventional cooling blankets

被引:143
作者
Merchant, Raina M. [1 ]
Abella, Benjamin S.
Peberdy, Mary Ann
Soar, Jasmeet
Ong, Marcus E. H.
Schmidt, Gregory A.
Becker, Lance B.
Vanden Hoek, Terry L.
机构
[1] Univ Chicago Hosp, Emergency Resuscitat Ctr, Sect Emergency Med, Chicago, IL 60637 USA
[2] Univ Chicago Hosp, Emergency Resuscitat Ctr, Sect Pulm & Crit Care, Chicago, IL 60637 USA
[3] Virginia Commonwealth Univ Hlth Syst, Dept Emergency Med, Richmond, VA USA
[4] Southmead Hosp N Bristol NHS Trust, Dept Anesthesia & Intens Care Med, Bristol, Avon, England
[5] Univ Penn, Dept Emergency Med, Philadelphia, PA 19104 USA
关键词
cardiac arrest; sudden cardiac death; hypothermia; resuscitation; body temperature regulation;
D O I
10.1097/01.CCM.0000246016.28679.36
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives. Although therapeutic hypothermia for cardiac arrest survivors has been shown to improve neurologically intact survival, optimal methods to ensure controlled induction and maintenance of cooling are not clearly established., Precise temperature control is important to evaluate because unintentional overcooling below the consensus target range of 32-34 degrees C may place the patient at risk for serious complications. We sought to measure the prevalence of overcooling (<32 degrees C) in postarrest survivors receiving primarily noninvasive cooling. Design: Retrospective chart review of postarrest patients. Setting. Three large teaching hospitals. Patients: Cardiac arrest survivors receiving therapeutic hypothermia. Interventions: Charts were reviewed if primarily surface cooling was used with a target temperature goal between 32 degrees C and 34 degrees C. Measurements and Main Results, Of the 32 cases reviewed, overcooling lasting for >1 hr was identified as follows: 20 of 32 patients (63%) reached temperatures of <32 degrees C, 9 of 32 (28%) reached temperatures of <31 degrees C, and 4 of 32 (13%) reached temperatures of <30 degrees C. Of those with overcooling of <32 degrees C, 6 of 20 (30%) survived to hospital discharge, whereas of those without overcooling, 7 of 12 (58%) survived to hospital discharge (p = not significant). Conclusions. The majority of the cases reviewed demonstrated unintentional overcooling below target temperature. Improved mechanisms for temperature control are required to prevent potentially deleterious complications of more profound hypothermia.
引用
收藏
页码:S490 / S494
页数:5
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