Two cases of asystolic cardiac arrests managed with therapeutic hypothermia
Piyush Narayan Mallick, Surjya Prasad Upadhyay, Raj Kumar A Singh
Keywords :
Asystole, prolonged cardiac arrest, return of spontaneous circulation, therapeutic hypothermia, and neurological outcome
Citation Information :
Mallick PN, Upadhyay SP, Singh RK. Two cases of asystolic cardiac arrests managed with therapeutic hypothermia. Indian J Crit Care Med 2013; 17 (2):113-115.
Poor neurological outcome is a common sequel of prolonged cardiac arrest. Although Therapeutic Hypothermia (TH) for neuroprotection has been a subject for research for over Half a century, its use has been limited because of many controversies and lack of clear guidelines. However for over two decades there has been a revival of interest in mild therapeutic hypothermia (32-34°C) for neuroprotection. However its use after primary asystolic cardiac arrest has been questioned.
Herein presenting two cases of prolonged asystolic arrest (39 minutes and 25 minutes); where therapeutic hypothermia was successfully used in following prolonged cardio pulmonary resuscitation. On patients who were in deep coma after resuscitation, TH was applied for 24 hours as per institutional protocol with full neurological recovery in both the cases. Therapeutic hypothermia might have a potential role in even in non-shockable arrests and should be considered in every successful cardiopulmonary resuscitation with poor neurological status.
Bernard SA, Jones BM, Horne MK. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med 1997;30:146-3.
The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549-6.
Bernard S, Buist M, Monteiro O, Smith K. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest : a0 preliminary report. Resuscitation 2003;56:9-13.
Arrich J, Holzer M, Havel C, Müllner M, Herkner H. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev 2012;9:CD004128.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J M 2002;346:557-63.
Neumar R W, Otto C W, Link M S, Kronick S L, Shuster M, Callaway C, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation 2010;122:S729-67.
Dumas F, Grimaldi D, Zuber B, Fichet J, Charpentier J, Pène F, et al. Is Hypothermia After Cardiac Arrest Effective in Both Shockable and Nonshockable Patients? Circulation 2011;123:877-86.
Polderman KH, Ingeborg H. Therapeutic hypothermia and controlled normothermia in the intensive care unit: Practical considerations, side effects, and cooling methods. Critical Care Medicine 2009;37:1101-20.
Polderman KH. Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality-part 2: Practical aspects and side effects. Intensive Care Med 2004;30:757-69.
