Therapeutic hypothermia after cardiac arrest: experience at an academically affiliated community-based veterans affairs medical center.
Therapeutic hypothermia after cardiac arrest: experience at an academically affiliated community-based veterans affairs medical center.
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DOI：
10.4061/2011/791639
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发表时间：
2011
影响因子：
1.5
通讯作者：
Yenari MA
中科院分区：
文献类型：
--
作者：
Shah MP;Zimmerman L;Bullard J;Yenari MA
在实验室和临床水平，治疗性低温已被证明可以改善心脏骤停后的神经功能结局和死亡率。我们回顾了三年来我们社区退伍军人事务医疗中心的每一次心脏骤停。大多数病例是与初始无脉性电活动或心搏停止相关的院内心脏骤停。在总共100名遭受118次心脏骤停的患者中，29次心脏骤停涉及昏迷的幸存者，其中8名患者完成了治疗性冷却。冷却队列在出院时和6个月时的脑功能分类评分显著优于非冷却队列，除1例外，所有病例均因适当原因提供冷却。开始冷却方案的平均时间为3.7小时，达到33°C目标温度的平均时间为8.8小时，在我们的病例系列中观察到与冷却明显相关的并发症很少。虽然心脏骤停的住院死亡率很高，在住院期间死亡率为65%，但在我们中心，治疗性低温是安全可行的。我们的冷却时间和有利结局的发生率与先前发表的报告相当。这项研究证明了实施的可行性，冷却协议的社区设置，和神经科医生在确保有效的医院范围内的实施的作用。
At laboratory and clinical levels, therapeutic hypothermia has been shown to improve neurologic outcomes and mortality following cardiac arrest. We reviewed each cardiac arrest in our community-based Veterans Affairs Medical Center over a three-year period. The majority of cases were in-hospital arrests associated with initial pulseless electrical activity or asystole. Of a total of 100 patients suffering 118 cardiac arrests, 29 arrests involved comatose survivors, with eight patients completing therapeutic cooling. Cerebral performance category scores at discharge and six months were significantly better in the cooled cohort versus the noncooled cohort, and, in every case except for one, cooling was offered for appropriate reasons. Mean time to initiation of cooling protocol was 3.7 hours and mean time to goal temperature of 33°C was 8.8 hours, and few complications clearly related to cooling were noted in our case series. While in-patient hospital mortality of cardiac arrest was high at 65% mortality during hospital admission, therapeutic hypothermia was safe and feasible at our center. Our cooling times and incidence of favorable outcomes are comparable to previously published reports. This study demonstrates the feasibility of implementing, a cooling protocol a community setting, and the role of neurologists in ensuring effective hospital-wide implementation.