C Adler1, R Pfister1, S Baldus1, H Reuter2. 1. Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland. 2. Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland. hannes.reuter@uk-koeln.de.
Abstract
BACKGROUND: The mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation and early revascularization strategies. The use of mild therapeutic hypothermia (MTH) for improvement of survival and neurological outcome in patients with cardiogenic shock is currently subject to renewed discussion. OBJECTIVE: The aim of this study was the detection of risk factors for mortality and morbidity in patients under MTH in cardiogenic shock following preclinical resuscitation for OHCA. METHODS: A total of 80 consecutive patients in cardiogenic shock after successful resuscitation (mean age 60 ± 3.2 years) treated with MTH were retrospectively analyzed. Patients were cooled to 33 °C for 24 h using an endovascular cooling device. Neurological outcome was assessed after 2 months based on the Glasgow-Pittsburgh cerebral performance category (CPC) and correlated with various blood parameter values. RESULTS: After 2 months 31 patients (39 %) showed a good neurological recovery with CPC scores of 1-2, 20 patients (25 %) had a poor neurological outcome with CPC scores of 3-4 and 29 (36 %) patients enrolled in the trial died (CPC 5). Patients with a poor outcome showed significantly higher mean serum levels for lactate, creatinine and urea. In addition, these patients showed a continuous increase of serum neuron-specific enolase (NSE) values in contrast to patients with a good outcome (∆ NSE from admission to day 1, CPC 1 and 2: - 10.6 ± 3 µg/l and CPC 3-5: 33 ± 12 µg/l, p = 0.02). CONCLUSION: Changes in the course of serum creatinine, urea and NSE levels within the first 72 h after OHCA could provide valuable additional information for the early assessment of the neurological prognosis in patients treated with MTH.
BACKGROUND: The mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation and early revascularization strategies. The use of mild therapeutic hypothermia (MTH) for improvement of survival and neurological outcome in patients with cardiogenic shock is currently subject to renewed discussion. OBJECTIVE: The aim of this study was the detection of risk factors for mortality and morbidity in patients under MTH in cardiogenic shock following preclinical resuscitation for OHCA. METHODS: A total of 80 consecutive patients in cardiogenic shock after successful resuscitation (mean age 60 ± 3.2 years) treated with MTH were retrospectively analyzed. Patients were cooled to 33 °C for 24 h using an endovascular cooling device. Neurological outcome was assessed after 2 months based on the Glasgow-Pittsburgh cerebral performance category (CPC) and correlated with various blood parameter values. RESULTS: After 2 months 31 patients (39 %) showed a good neurological recovery with CPC scores of 1-2, 20 patients (25 %) had a poor neurological outcome with CPC scores of 3-4 and 29 (36 %) patients enrolled in the trial died (CPC 5). Patients with a poor outcome showed significantly higher mean serum levels for lactate, creatinine and urea. In addition, these patients showed a continuous increase of serum neuron-specific enolase (NSE) values in contrast to patients with a good outcome (∆ NSE from admission to day 1, CPC 1 and 2: - 10.6 ± 3 µg/l and CPC 3-5: 33 ± 12 µg/l, p = 0.02). CONCLUSION: Changes in the course of serum creatinine, urea and NSE levels within the first 72 h after OHCA could provide valuable additional information for the early assessment of the neurological prognosis in patients treated with MTH.
Authors: Jerry P Nolan; Jasmeet Soar; David A Zideman; Dominique Biarent; Leo L Bossaert; Charles Deakin; Rudolph W Koster; Jonathan Wyllie; Bernd Böttiger Journal: Resuscitation Date: 2010-10 Impact factor: 5.262
Authors: Martin Annborn; John Bro-Jeppesen; Niklas Nielsen; Susann Ullén; Jesper Kjaergaard; Christian Hassager; Michael Wanscher; Jan Hovdenes; Tommaso Pellis; Paolo Pelosi; Matt P Wise; Tobias Cronberg; David Erlinge; Hans Friberg Journal: Intensive Care Med Date: 2014-07-08 Impact factor: 17.440
Authors: J S Hochman; L A Sleeper; J G Webb; T A Sanborn; H D White; J D Talley; C E Buller; A K Jacobs; J N Slater; J Col; S M McKinlay; T H LeJemtel Journal: N Engl J Med Date: 1999-08-26 Impact factor: 91.245
Authors: Jennifer E Fugate; Eelco F M Wijdicks; Jay Mandrekar; Daniel O Claassen; Edward M Manno; Roger D White; Malcolm R Bell; Alejandro A Rabinstein Journal: Ann Neurol Date: 2010-12 Impact factor: 10.422
Authors: Karl Werdan; Martin Ruß; Michael Buerke; Georg Delle-Karth; Alexander Geppert; Friedrich A Schöndube Journal: Dtsch Arztebl Int Date: 2012-05-11 Impact factor: 5.594
Authors: Stephen Trzeciak; Alan E Jones; J Hope Kilgannon; Barry Milcarek; Krystal Hunter; Nathan I Shapiro; Steven M Hollenberg; Phillip Dellinger; Joseph E Parrillo Journal: Crit Care Med Date: 2009-11 Impact factor: 7.598
Authors: Markus Flesch; Jens Hagemeister; Hans-Joerg Berger; Annett Schiefer; Sylke Schynkowski; Martin Klein; Sassan Sahebdjami; Stephan vom Dahl; Wolfgang Fehske; Rudolf Mies; Michael von Eiff; Holger Pfaff; Peter Frommolt; Hans-Wilhelm Hoepp Journal: Circ Cardiovasc Interv Date: 2008-09-03 Impact factor: 6.546
Authors: C Adler; C Paul; J Hinkelbein; G Michels; R Pfister; A Krings; A Lechleuthner; R Stangl Journal: Anaesthesist Date: 2018-04-17 Impact factor: 1.041
Authors: J W Erath; J Hodrius; P Bushoven; S Fichtlscherer; A M Zeiher; F H Seeger; J Honold Journal: Med Klin Intensivmed Notfmed Date: 2016-11-02 Impact factor: 0.840