%0 Journal Article
%T Improved Survival with Therapeutic Hypothermia after Cardiac Arrest with Cold Saline and Surfacing Cooling: Keep It Simple
%A Cristina Granja
%A Pedro Ferreira
%A Orqu赤dea Ribeiro
%A Joˋo Pina
%J Emergency Medicine International
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/395813
%X Aim. To evaluate whether the introduction of a therapeutic hypothermia (TH) protocol consisting of cold saline infusion and surface cooling would be effective in targeting mild therapeutic hypothermia (32每34∼C). Additionally, to evaluate if TH would improve survival after cardiac arrest. Design. Before-after design. Setting. General Intensive Care Unit (ICU) at an urban general hospital with 470 beds. Patients and Methods. Patients admitted in the ICU after cardiac arrest between 2004 and 2009 were included. Effectiveness of the TH protocol to achieve the targeted temperature was evaluated. Hospital mortality was compared before (October 2004每March 2006) and after (April 2006每September 2009) the protocol implementation. Results. Hundred and thirty patients were included, 75 patients were not submitted to TH (before TH group), and 55 were submitted to TH (TH group). There were no significant differences concerning baseline, ICU, and cardiac arrest characteristics between both groups. There was a significant reduction in hospital mortality from 61% ( ) in the before TH group to 40% ( ) in the TH group. Conclusion. Our protocol consisting of cold saline infusion and surface cooling might be effective in inducing and maintaining mild therapeutic hypothermia. TH achieved with this protocol was associated with a significant reduction in hospital mortality. 1. Introduction The outcome after cardiac arrest is still poor [1], with only 7% to 30% of the patients being discharged from hospital with good neurologic outcome [1]. Therapeutic hypothermia (TH) can improve survival and the neurological outcome [2, 3] after cardiac arrest. Previous and current guidelines recommend TH in comatose survivors of cardiac arrest associated with nonshockable rhythms as well as shockable rhythms, acknowledging, however, the lower level of evidence for use after cardiac arrest from non-shockable rhythms [4, 5]. The effect of hypothermia on the neurological outcome would seem to be most beneficial when the treatment is initiated as early as possible after restoration of spontaneous circulation (ROSC) and maintained for 12每24ˋh [6]. A recent metanalysis [1, 7] and a revision of the literature [8] have confirmed the benefit of the TH even outside the scope of randomized controlled trials. While several methods of cooling are currently applied [6每14], there is no proof of superiority of any cooling method above others, and there are currently no formal cost-benefit analyses [1]. Surface cooling is generally considered the least expensive and is probably the most widely used [15每17].
%U http://www.hindawi.com/journals/emi/2011/395813/