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therapeutic hypothermia in survivors  of cardiac arrest Sherry Goldyn, MD, MPH Pulmonary/Critical Care July 13, 2011
Therapeutic hypothermia (TH) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Incidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Incidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post cardiac arrest syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post cardiac arrest syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post-cardiac arrest ,[object Object],[object Object],[object Object],[object Object]
Clinical Performance Category Lancet 1975. 1(7905):480-4 CPC 5.  Brain death: apnea, areflexia, EEG silence, etc. CPC 4 . Coma or vegetative state: any degree of coma without the presence of all brain death criteria. Unawareness, even if appears awake (vegetative state) without interaction with environment; may have spontaneous eye opening and sleep/awake cycles. Cerebral unresponsiveness. CPC 3.  Severe cerebral disability: conscious, dependent on others for daily support because of impaired brain function. Ranges from ambulatory state to severe dementia or paralysis CPC 2.  Moderate cerebral disability: conscious, sufficient cerebral function for independent activities of daily life. Able to work in sheltered environment CPC 1.  Good cerebral performance: conscious, alert, able to work, might have mild neurologic or psychologic deficit
Pathophysiology of anoxic injury  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object],Pathophysiology of anoxic injury
Rationale for cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Historical context ,[object Object],[object Object],[object Object],[object Object],[object Object]
Historical context ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fay T, Early experiences with local and generalized refrigeration of the human brain, Journal of Neurosurgery, May, 1959, number 3; 16:239-260, 
Historical context ,[object Object],[object Object],[object Object]
 
Ann Surg. 1958 September; 148(3): 462–466
[object Object]
 
Hypothermia after Cardiac Arrest Group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypothermia after Cardiac Arrest Group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Hypothermia after Cardiac Arrest Study Group. N Engl J Med 2002;346:549-556
The Hypothermia after Cardiac Arrest Study Group. N Engl J Med 2002;346:549-556
Cumulative Survival The Hypothermia after Cardiac Arrest Study Group. N Engl J Med 2002;346:549-556
 
Induced hypothermia  after out-of-hospital cardiac arrest ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bernard, S. et al. N Engl J Med 2002;346:557-563
Induced hypothermia after out-of-hospital cardiac arrest ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Crit Care Med 2009; 37(7):S223-S226.
Cooling techniques ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cool Gard with Icy Femoral Catheter
Arctic Sun
Physiologic effects of cooling
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic effects of cooling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Kaiser NCAL  Therapeutic Hypothermia protocol
Kaiser NCAL hypothermia protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Maintenance cooling
Re-warming phase
 
 
 
 
 
Post-warming ,[object Object],[object Object],[object Object],[object Object]
[object Object]
Current recommendations ,[object Object],[object Object]
Current recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Further research ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Further research ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 

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Noon Conf: Therapeutic hypothermia

  • 1. therapeutic hypothermia in survivors of cardiac arrest Sherry Goldyn, MD, MPH Pulmonary/Critical Care July 13, 2011
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8. Clinical Performance Category Lancet 1975. 1(7905):480-4 CPC 5. Brain death: apnea, areflexia, EEG silence, etc. CPC 4 . Coma or vegetative state: any degree of coma without the presence of all brain death criteria. Unawareness, even if appears awake (vegetative state) without interaction with environment; may have spontaneous eye opening and sleep/awake cycles. Cerebral unresponsiveness. CPC 3. Severe cerebral disability: conscious, dependent on others for daily support because of impaired brain function. Ranges from ambulatory state to severe dementia or paralysis CPC 2. Moderate cerebral disability: conscious, sufficient cerebral function for independent activities of daily life. Able to work in sheltered environment CPC 1. Good cerebral performance: conscious, alert, able to work, might have mild neurologic or psychologic deficit
  • 9.
  • 10.  
  • 11.
  • 12.
  • 13.
  • 14.
  • 15. Fay T, Early experiences with local and generalized refrigeration of the human brain, Journal of Neurosurgery, May, 1959, number 3; 16:239-260, 
  • 16.
  • 17.  
  • 19.
  • 20.  
  • 21.
  • 22.
  • 23. The Hypothermia after Cardiac Arrest Study Group. N Engl J Med 2002;346:549-556
  • 24. The Hypothermia after Cardiac Arrest Study Group. N Engl J Med 2002;346:549-556
  • 25. Cumulative Survival The Hypothermia after Cardiac Arrest Study Group. N Engl J Med 2002;346:549-556
  • 26.  
  • 27.
  • 28. Bernard, S. et al. N Engl J Med 2002;346:557-563
  • 29.
  • 30. Crit Care Med 2009; 37(7):S223-S226.
  • 31.
  • 32. Cool Gard with Icy Femoral Catheter
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49. Kaiser NCAL Therapeutic Hypothermia protocol
  • 50.
  • 51.  
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  • 55.  
  • 56.  
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  • 66.