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Therapeutic hypothermia with esophageal heat transfer device
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Abstracts / Resuscitation 96S (2015) 43–157
AP231 Therapeutic hypothermia with esophageal heat transfer device Andrej Markota ∗ , Jure Fluher, Petra Balazic, Barbara Kit, Andreja Sinkovic University Medical Centre Maribor, Maribor, Slovenia Purpose of the study: To evaluate the performance of esophageal heat transfer device (EHTD) in inducing, maintaining, and reversing therapeutic hypothermia in adult survivors of cardiac arrest. Materials and methods: We performed a prospective, interventional study from March to May 2015. EHTD (Esophageal Cooling Device, Advanced Cooling Therapy, Chicago, IL, USA) was inserted after admission and connected to chiller (CritiCool, MTRE, Rehovot, Israel). Study protocol was to achieve target temperature (32–34 ◦ C in urinary bladder) within 1 h after admission, maintain it until 24 h after admission and rewarm to 36 ◦ C at a rate 0.25–0.5 ◦ C/h. Iced saline infusion during induction (1000 ml for initial temperature 34.1–35 ◦ C and 20 ml/kg if ≥35.1 ◦ C) and external cooling/rewarming during maintenance and rewarming (for temperature outside the desired range for ≥2 h) were allowed. Minor fluctuations were defined as <0.5 ◦ C outside the desired range. Results: We included 13 patients, 12 (92%) males. Mean age was 65 ± 14 years, weight 79 ± 17 kg (range 56–126 kg), initial temperature 35.1 ± 1.1 ◦ C, time to target temperature 99 ± 96 min, and iced saline volume during induction 1538 ± 853 ml. Target temperature was reached in all patients and maintained within desired range in 6. Minor fluctuations occurred in 4 and unwanted rewarming in 3 patients (in these 3 patients external cooling and neuromuscular blocking agents were used additionally). Mean rate of rewarming was 0.3 ± 0.1 ◦ C/h. Rewarming with EHTD was unsuccessful in one patient (external rewarming used, the patient died after 4 days in cardiogenic shock and multiorgan failure). Conclusion: EHTD induced therapeutic hypothermia with approximately half of volume of iced saline as proposed by current guidelines.1 It enabled good temperature control during maintenancee and rewarming phases.
Reference 1. Deakin CD, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010;81:1305–52.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.328 AP232 Central diabetes insipidus in post-cardiac arrest patients treated with therapeutic hypothermia Yun woo Seong ∗ , Kathy Minjung Chae, Jeong Hoon Lee, Tae Rim Lee, Hee Yoon, Sung Yeon Hwang, Won Chul Cha, Tae Gun Shin, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong, Min Seob Sim Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Purpose: Development of central diabetes insipidus (CDI) after acute brain injury is a known sign of severity. We aimed to analyse the outcomes of patients diagnosed with CDI in a homogeneous
group of patients who underwent therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA). Methods: We retrospectively analysed OHCA data from a prospectively documented database at a single-centre between Jan. 2010 and Mar. 2015. 160 OHCA patients treated with TH were included, excluding patients who died within 7 days of cardiac arrest or whose families refused further treatment. Patients diagnosed with CDI, along with arrest data and hypothermia data and 1 month cerebral performance category (CPC) scores were collected. Results: 35 of 160 patients (21.6%) were in the CDI group. All CDI patients had a neurologic outcome of either CPC 4 (14.3%) or CPC 5 (85.7%). In CPC 5 patients, the CDI patients were younger than non CDI patients (43.8 ± 15.3 vs. 62.1 ± 14.0, p < 0.01). Hanging (n = 10 (33.3%) vs. n = 1 (3.2%)) and respiratory arrest (n = 10 (33.3%) vs. n = 5 (16.1%) were more common in CDI patients than non-CDI CPC 5 patients (p < 0.01). Comparison of CDI patients by 1 month CPC score showed that the median onset of DI was earlier in patients with CPC 5 compared to patients with a CPC score of 4 (4 days (1 to 5) vs. 8 days (7 to 8), p < 0.01). Conclusions: All patients diagnosed with CDI had poor neurologic outcomes. Patients with one month CPC 5 had earlier occurrence of CDI (p < 0.01), compared to CPC 4 patients. http://dx.doi.org/10.1016/j.resuscitation.2015.09.329 AP233 Out-of-hospital cardiac arrest survivors with cognitive problems have lower exercise capacity than patients without cognitive problems Carlien Reinders 1 , Liesbeth Boyce 2,∗ , Thea Vliet Vlieland 3 , Henk van Exel 2 , Gerard Volker 2 , Esther Loss van Mechelen 1 , Paulien Goossens 2 1
Sophia Rehabilitation Centre, Den Haag, The Netherlands 2 Rijnlands Rehabilitation Centre, Leiden, The Netherlands 3 Leids University Medical Centre, Leiden, The Netherlands Purpose of the study: Survival after out-of-hospital cardiac arrest (OHCA) is approximately 23% in the Netherlands1 Hypoxic brain injury is described in 40% of survivors.2 It is unknown if exercise capacity of patients with cognitive problems differs from other OHCA survivors. This study determines exercise capacity in OHCA survivors with and without cognitive problems. Materials and methods: This prospective study included 53 patients with myocardial infarction (MI) as cause of OHCA. Cognitive problems were measured with Mini-Mental State Examination (MMSE; cut-off <28), Cognitive Failures Questionnaire (CFQ; cutoff >32) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE; cut-off >3.6). Cardiopulmonary exercise tests (CPET) on a bicycle ergometer were performed at start of rehabilitation. Exercise capacity (VO2 max) and work load (Watts) were measured at maximum exercise, heart rate (bpm) and blood pressure (mmHg) at rest and at maximum exercise. Metabolic equivalents (MET) were calculated. Results: Cognitive problems were reported in 9 of 53 patients (17%). Significant differences (p < 0.05) were found between patients with and without cognitive problems for VO2max (19.7 vs 14.5 ml/kg/min), work load (124 vs 86 W) and MET’s (5.6 vs 4.1). No significant differences for heart rate or blood pressure were found. Conclusions: In patients referred for cardiac rehabilitation with OHCA caused by MI correlations between cognitive problems and lower exercise capacity were found. Further studies on exercise
Abstracts / Resuscitation 96S (2015) 43–157
AP231 Therapeutic hypothermia with esophageal heat transfer device Andrej Markota ∗ , Jure Fluher, Petra Balazic, Barbara Kit, Andreja Sinkovic University Medical Centre Maribor, Maribor, Slovenia Purpose of the study: To evaluate the performance of esophageal heat transfer device (EHTD) in inducing, maintaining, and reversing therapeutic hypothermia in adult survivors of cardiac arrest. Materials and methods: We performed a prospective, interventional study from March to May 2015. EHTD (Esophageal Cooling Device, Advanced Cooling Therapy, Chicago, IL, USA) was inserted after admission and connected to chiller (CritiCool, MTRE, Rehovot, Israel). Study protocol was to achieve target temperature (32–34 ◦ C in urinary bladder) within 1 h after admission, maintain it until 24 h after admission and rewarm to 36 ◦ C at a rate 0.25–0.5 ◦ C/h. Iced saline infusion during induction (1000 ml for initial temperature 34.1–35 ◦ C and 20 ml/kg if ≥35.1 ◦ C) and external cooling/rewarming during maintenance and rewarming (for temperature outside the desired range for ≥2 h) were allowed. Minor fluctuations were defined as <0.5 ◦ C outside the desired range. Results: We included 13 patients, 12 (92%) males. Mean age was 65 ± 14 years, weight 79 ± 17 kg (range 56–126 kg), initial temperature 35.1 ± 1.1 ◦ C, time to target temperature 99 ± 96 min, and iced saline volume during induction 1538 ± 853 ml. Target temperature was reached in all patients and maintained within desired range in 6. Minor fluctuations occurred in 4 and unwanted rewarming in 3 patients (in these 3 patients external cooling and neuromuscular blocking agents were used additionally). Mean rate of rewarming was 0.3 ± 0.1 ◦ C/h. Rewarming with EHTD was unsuccessful in one patient (external rewarming used, the patient died after 4 days in cardiogenic shock and multiorgan failure). Conclusion: EHTD induced therapeutic hypothermia with approximately half of volume of iced saline as proposed by current guidelines.1 It enabled good temperature control during maintenancee and rewarming phases.
Reference 1. Deakin CD, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010;81:1305–52.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.328 AP232 Central diabetes insipidus in post-cardiac arrest patients treated with therapeutic hypothermia Yun woo Seong ∗ , Kathy Minjung Chae, Jeong Hoon Lee, Tae Rim Lee, Hee Yoon, Sung Yeon Hwang, Won Chul Cha, Tae Gun Shin, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong, Min Seob Sim Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Purpose: Development of central diabetes insipidus (CDI) after acute brain injury is a known sign of severity. We aimed to analyse the outcomes of patients diagnosed with CDI in a homogeneous
group of patients who underwent therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA). Methods: We retrospectively analysed OHCA data from a prospectively documented database at a single-centre between Jan. 2010 and Mar. 2015. 160 OHCA patients treated with TH were included, excluding patients who died within 7 days of cardiac arrest or whose families refused further treatment. Patients diagnosed with CDI, along with arrest data and hypothermia data and 1 month cerebral performance category (CPC) scores were collected. Results: 35 of 160 patients (21.6%) were in the CDI group. All CDI patients had a neurologic outcome of either CPC 4 (14.3%) or CPC 5 (85.7%). In CPC 5 patients, the CDI patients were younger than non CDI patients (43.8 ± 15.3 vs. 62.1 ± 14.0, p < 0.01). Hanging (n = 10 (33.3%) vs. n = 1 (3.2%)) and respiratory arrest (n = 10 (33.3%) vs. n = 5 (16.1%) were more common in CDI patients than non-CDI CPC 5 patients (p < 0.01). Comparison of CDI patients by 1 month CPC score showed that the median onset of DI was earlier in patients with CPC 5 compared to patients with a CPC score of 4 (4 days (1 to 5) vs. 8 days (7 to 8), p < 0.01). Conclusions: All patients diagnosed with CDI had poor neurologic outcomes. Patients with one month CPC 5 had earlier occurrence of CDI (p < 0.01), compared to CPC 4 patients. http://dx.doi.org/10.1016/j.resuscitation.2015.09.329 AP233 Out-of-hospital cardiac arrest survivors with cognitive problems have lower exercise capacity than patients without cognitive problems Carlien Reinders 1 , Liesbeth Boyce 2,∗ , Thea Vliet Vlieland 3 , Henk van Exel 2 , Gerard Volker 2 , Esther Loss van Mechelen 1 , Paulien Goossens 2 1
Sophia Rehabilitation Centre, Den Haag, The Netherlands 2 Rijnlands Rehabilitation Centre, Leiden, The Netherlands 3 Leids University Medical Centre, Leiden, The Netherlands Purpose of the study: Survival after out-of-hospital cardiac arrest (OHCA) is approximately 23% in the Netherlands1 Hypoxic brain injury is described in 40% of survivors.2 It is unknown if exercise capacity of patients with cognitive problems differs from other OHCA survivors. This study determines exercise capacity in OHCA survivors with and without cognitive problems. Materials and methods: This prospective study included 53 patients with myocardial infarction (MI) as cause of OHCA. Cognitive problems were measured with Mini-Mental State Examination (MMSE; cut-off <28), Cognitive Failures Questionnaire (CFQ; cutoff >32) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE; cut-off >3.6). Cardiopulmonary exercise tests (CPET) on a bicycle ergometer were performed at start of rehabilitation. Exercise capacity (VO2 max) and work load (Watts) were measured at maximum exercise, heart rate (bpm) and blood pressure (mmHg) at rest and at maximum exercise. Metabolic equivalents (MET) were calculated. Results: Cognitive problems were reported in 9 of 53 patients (17%). Significant differences (p < 0.05) were found between patients with and without cognitive problems for VO2max (19.7 vs 14.5 ml/kg/min), work load (124 vs 86 W) and MET’s (5.6 vs 4.1). No significant differences for heart rate or blood pressure were found. Conclusions: In patients referred for cardiac rehabilitation with OHCA caused by MI correlations between cognitive problems and lower exercise capacity were found. Further studies on exercise