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Therapeutic hypothermia in cardiac arrest survivors: is rebound hyperthermia a significant issue with intravascular cooling?
Intensive Care Medicine Experimental volume 3, Article number: A201 (2015)
Out-of-Hospital Cardiac Arrest (OOHCA) is associated with a poor prognosis. Targeted temperature management (TTM) within Intensive Care (ICU) including therapeutic hypothermia (TH) aims to reduce cerebral reperfusion injury and improve neurological outcomes.
Within Northern Ireland (NI), Craigavon Area Hospital (CAH) is the only ICU to implement TH using an intravascular cooling device (Coolgard 3000©, Alsius UK®)
The benefit of TH has recently been disputed and many ICUs within NI have since adopted TTM to 36°C in survivors of OOHCA .
In view of this we aimed to benchmark our use of TH to 32-34°C, using intravascular cooling against best practice at the time of data collection.
Retrospective, observational chart-based data collection.
40 patients admitted to CAH ICU, who received TH via intravascular cooling catheter (24/5/2010-30/11/2012), were identified from the Intensive Care National Audit and Research Centre (ICNARC) database.
35 patients (87.5%) had available relevant and complete data.
Overall our outcomes for a mixed ICU population with broad inclusion criteria for TH are comparable with those of published studies .
The use of intravascular cooling for TH was associated with minimal use of muscle relaxants allowing early neurological prognostication in our patient group.
However intravascular cooling to 32-34°C was associated with prolonged periods of rebound hyperthermia in a significant minority of patients (45.1%, mean time 8.6 hours).
We believe that TH to 32-34°C, using intravascular cooling, increases the risk of developing a rebound hyperthermia that could potentially exacerbate acquired neurological injury.
Our data supports the use of TTM to 36°C to mitigate any potential effect of rebound hyperthermia is this patient group.
Neilson , et al: Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. N Engl J Med. 2013, 369: 2197-22062.
The Hypothermia after cardiac arrest study group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002, 346: 549-563.
Bernard SA, Gray TW, Buist MD, et al: Treatment of Comatose survivors of cardiac arrest with induced hypothermia. N Engl J Med. 2002, 346: 557-63.
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Price, T., Poots, C., Shields, H. et al. Therapeutic hypothermia in cardiac arrest survivors: is rebound hyperthermia a significant issue with intravascular cooling?. ICMx 3, A201 (2015). https://doi.org/10.1186/2197-425X-3-S1-A201
- Therapeutic Hypothermia
- Target Temperature Management
- Northern Ireland
- Cardiac Arrest Survivor
- Broad Inclusion Criterion