Vojnosanitetski pregled 2011 Volume 68, Issue 6, Pages: 495-499
https://doi.org/10.2298/VSP1106495P
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Therapeutic hypothermia and neurological outcome after cardiac arrest
Petrović Milovan (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiology, Sremska Kamenica)
Panić Gordana (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiology, Sremska Kamenica)
Jovelić Aleksandra (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiology, Sremska Kamenica)
Čanji Tibor (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiology, Sremska Kamenica)
Srdanović Ilija (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiology, Sremska Kamenica)
Popov Tanja (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiology, Sremska Kamenica)
Golubović Miodrag (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica)
Introduction/Aim. The most important clinically relevant cause of global
cerebral ischemia is cardiac arrest. Clinical studies showed a marked
neuroprotective effect of mild hypothermia in resuscitation. The aim of this
study was to evaluate the impact of mild hypothermia on neurological outcome
and survival of the patients in coma, after cardiac arrest and return of
spontaneous circulation. Methods. The prospective study was conducted on
consecutive comatose patients admitted to our clinic after cardiac arrest and
return of spontaneous circulation, between February 2005 and May 2009. The
patients were divided into two groups: the patients treated with mild
hypothermia and the patients treated conservatively. The intravascular in
combination with external method of cooling or only external cooling was used
during the first 24 hours, after which spontaneous rewarming started. The
endpoints were survival rate and neurological outcome. The neurological
outcome was observed with Cerebral Performance Category Scale (CPC).
Follow-up was 30 days. Results. The study was conducted on 82 patients: 45
patients (age 57.93 ± 14.08 years, 77.8% male) were treated with hypothermia,
and 37 patients (age 62.00 ± 9.60 years, 67.6% male) were treated
conservatively. In the group treated with therapeutic hypothermia protocol,
21 (46.7%) patients had full neurological restitution (CPC 1), 3 (6.7%)
patients had good neurologic outcome (CPC 2), 1 (2.2%) patient remained in
coma and 20 (44.4%) patients finally died (CPC 5). In the normothermic group
7 (18.9%) patients had full neurological restitution (CPC 1), and 30 (81.1%)
patients remained in coma and finally died (CPC 5). Between the two
therapeutic groups there was statistically significant difference in
frequencies of different neurologic outcome (p = 0.006), specially between
the patients with CPC 1 and CPC 5 outcome (p = 0.003). In the group treated
with mild hypothermia 23 (51.1%) patients survived, and in the normothermic
group 30 (81.1%) patients died, while in the group of survived patients 23
(76.7%) were treated with mild hypothermia (p = 0.003). Conclusion. Mild
therapeutic hypothermia applied after cardiac arrest improved neurological
outcome and reduced mortality in the studied group of comatose survivors.
Keywords: heart arrest, hypothermia, induced, neurologic manifestations, treatment outcome, mortality
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