THERAPEUTIC HYPOTHERMIA FOR POSTRESUSCITATION SYNDROME AND LACTATE LEVELS Sule AKIN, Assoc.Prof, MD Baskent University School of Medicine Anestehsiology and Critical Care Department Adana - TURKEY 2 nd World Congress on BIOMARKERS & CLINICAL RESEARCH Baltimore, Maryland , USA. – 13 September 2011
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Therapeutic hypothermia for postresuscitation syndrome and lactate levels
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THERAPEUTIC HYPOTHERMIA FOR POSTRESUSCITATION SYNDROME AND LACTATE
LEVELS
Sule AKIN, Assoc.Prof, MDBaskent University School of Medicine
Anestehsiology and Critical Care DepartmentAdana - TURKEY
2nd World Congress on BIOMARKERS & CLINICAL RESEARCH Baltimore, Maryland , USA. – 13 September 2011
N Engl J Med 2002 Feb 21;346(8):557-63Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Guttridge G, Smith K.
N Engl J Med 2002 Feb 21;346(8):549-56Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.Hypothermia after Cardiac Arrest Study Group (HACA).
Resuscitation 2001 Dec;51(3):275-81Mild hypothermia induced by a helmet device: a clinical feasibility study.Hachimi-Idrissi S, Corne L, Ebinger G, Michotte Y, Huyghens L.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summaryJerry P. Nolana, Jasmeet Soarb, David A. Zidemanc, Dominique Biarentd, Leo L. Bossaerte, Charles Deakinf, Rudolph W. Kosterg, Jonathan Wyllieh, Bernd Böttigeri, on behalf of the ERC Guidelines Writing Group1Therapeutic HypothermiaThere is good evidence supporting the use of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest caused by VF. One randomised trial704 and a pseudorandomised trial669 demonstrated improved neurological outcome at hospital discharge or at 6 months in comatose patients after out-of-hospital VF cardiac arrest. Cooling was initiated within minutes to hours after ROSC and a temperature range of 32–34 ◦C was maintained for 12–24 h. Two studies with historical control groups showed improvement in neurological outcome after therapeutic hypothermia for comatose survivors of VF cardiac arrest.705–707 Extrapolation of these data to other cardiac arrests (e.g., other initial rhythms, in-hospital arrests, paediatric patients) seems reasonable but is supported by only lower level data.
Out-of-hospital CPR, In –hospital CPR VF, PVT, Asistoly, PEA First 6 hours, 32-34 C
For 12-24 hours
TH – TO WHOM WE CAN’T APPLY?• Awake patients
• Myoclonus, status epilepticus
• Severe coagulopathy and active bleeding
• Haemodynamic instability
• Resistant arrhythmia
• Septic shock
• Delayed cases ( >12 hours)
• Suspicious intracranial hemorrhage
• Pregnancy
TH – ADVERSE EFFECTS
CARDIVASCULAR HEMATOLOGIC IMMUNOLOGIC METABOLIC
- Arrhythmia -Platelet dysfunction
-Coagulopathy
-Neutrophil dysfunction
- Infection
-Hypocalemia
-Hyperglisemia
-İleus
- Pancreatitis
• Increases due to cooling duration and intensity
POSTRESUSCITATION
SYNDROME (PRS)
POST CARDIAC ARREST
SYNDROME
SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS)
PRS
Cardiac arrest
ROSC (+)25%
ROSC (-) 75 %
Recovery 7%
PRS18%
Alive 3%
Dead15%
ROSC: Return Of Sontaneous Circulation
İSKEMİ
Blockage Muscle
Blood flow
ischemia
O2
Ca+2Necrosis
Apoptosis
Cell Death
Necrosis
Apoptosis
Cell Death
Inflammation
REPERFUSION
Clot DissolutionFlow Restoration
Oxidative Stress
Mitochondrial Resp. ChainNAD(P)H OxidasesNitric Oxide Synthesas