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Intra-arrest therapeutische hypothermie Fabienne Roossien, AIOS SEH Regionaal refereren 18-07-2013

Intra-arrest therapeutische hypothermie Fabienne Roossien, AIOS SEH Regionaal refereren 18-07-2013. Inhoud. Achtergrond Search Studies Conclusie Discussie THM. Achtergrond. Dierstudies: Intra-arrest TH 1-4 : betere kans op ROSC & survival betere neurologische uitkomst

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Intra-arrest therapeutische hypothermie Fabienne Roossien, AIOS SEH Regionaal refereren 18-07-2013

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  1. Intra-arrest therapeutische hypothermie Fabienne Roossien, AIOS SEH Regionaal refereren 18-07-2013

  2. Inhoud • Achtergrond • Search • Studies • Conclusie • Discussie • THM

  3. Achtergrond • Dierstudies: • Intra-arrest TH 1-4: • betere kans op ROSC & survival • betere neurologische uitkomst • Veilig, uitvoerbaar 5-7 • Effect mensen?

  4. Search

  5. Search • Medline/CINAHL: • Intra-arr*/ intra arr* AND hypothermia • 27 hits => 2 relevant • Embase • Therapeutic/Induced hypothermia AND intra-arrest • 63 hits=> 6 relevant, 3 cf. pubmed, 3 abstracts (2 AHA congres 2011; 1 Critical Care congres 2011)

  6. Artikelen • Castren et al.Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC intranasal cooling effectiveness).Circulation 2010; 122: 729-736 • Garret et al.The association between intra-arrest therapeutic hypothermia and return of spontaneous circulation among individuals experiencing out of hospital cardiac arrestResuscitation 82 (2011) 21–25

  7. Abstracts • J. FreeseIntra-arrest induction of therapeutic hypothermia via large-volume ice-cold saline infusion improves immediate outcomes for out-of-hospital cardiac arrestIntra-arrest induction of therapeutic hypothermia via large-volume, ice-cold saline infusion results in improved outcomes among out-of-hospital cardiac arrests of cardiac etiologyCirculation 2011 124: A97& A2 • Castren et al.Earlier intra-arrest transnasal cooling may be beneficialCritical care 2011, 15(suppl):P303

  8. Conclusie studies • IATH middels infusie/transnasaal • Veilig en haalbaar • Trend naar meer ROSC, • Wschl. ook meer survival en betere neurologie • M.n. bij snelle start CPR en snelle start IATH

  9. Discussie • Beperkte humane studies • Abstracts veelbelovend, grote aantallen, nog niet uitgewerkt • Meer ROSC bij IATH • Relatie ROSC-survival-neurologie nog niet bewezen • Meer RCT’s nodig met primaire doel survival/ neurologie

  10. THM • O.b.v. eerder onderzoek: • geen adverse events, IATH haalbaar, neiging naar meer ROSC • Positief effect • Echter: veilig en haalbaar, dus… • Keep it cool & fast!

  11. Vragen?

  12. Referenties • Nozari et al. Critical time window for intra-arrest cooling with cold-saline flush in a dog model of CPR Circulation 2006; 113; 2690-6 • Zhao et al. Intra-arrest cooling with delayed reperfusion yields higher survival than earier normothermic resuscitatoion in a mouse-model. Resuscitation 2008; 77:242-9 • Abella et al. Intra-arrest cooling improves outcomes in a murine cardiac arrest model. Circulation 2004; 109:2786-91 • Menegazzi et al Effects of pre-arrest and intra-arrest hypothermia on ventricular defirillation and resuscitation Resuscitation 2009; 80:126-32 • Bernard et al. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 2003, 56:9-13. • Kim F et al. Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-ofhospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation 2007, 115:3064-3070. • Virkkunen I et al. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study. Resuscitation 2004, 62:299-302. • Castren et al. Intra-arrest transnasalevaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC intranasal cooling effectiveness). Circulation 2010; 122: 729-736 • Garret et al. The association between intra-arrest therapeutic hypothermia and return of spontaneous circulation among individuals experiencing out of hospital cardiac arrest Resuscitation 82 (2011) 21–25 • Scolletta et al. Intra-arrest hypothermia during cardiac arrest: a systematic review. Critical Care 2012, 16:R41 • Freese Intra-arrest Induction of Therapeutic Hypothermia via Large-Volume, Ice-Cold Saline Infusion Results in Improved Outcomes Among Out-of-Hospital Cardiac Arrests of Cardiac Etiology • Freese Intra-arrest Induction of Therapeutic Hypothermia via Large-Volume Ice-Cold Saline Infusion Improves Immediate Outcomes for Out-of-Hospital Cardiac Arrest • Castren et al . Earlier intra-arrest transnasal cooling may be beneficialCritical care 2011, 15(suppl):P303

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