Induced hypothermia after cardiac arrest

Niklas Nielsen

Induced hypothermia after cardiac arrest

Niklas Nielsen

Anestesiologi och intensivvård

Forskningsoutput: Avhandling › Doktorsavhandling (sammanläggning)

352 Nedladdningar (Pure)

Sammanfattning

Popular Abstract in Swedish
Bakgrund: Nio av tio patienter som läggs in på sjukhus efter hjärtstillestånd utanför sjukhus är medvetslösa och behöver intensivvård. Dödligheten och risken för varaktiga hjärnskador är stor. Förhöjd kroppstemperatur under intensivvården är förenat med sämre överlevnad och hjärnfunktion. Nedkylning har i djurexperimentella och preliminära kliniska studier visat sig vara gynnsamt.
Metod: Information om hjärtstoppspatienter som behandlats med nedkylning har samlats in systematisk. Vi har bedömt överlevnad, neurologisk funktion, utförande av nedkylning, risk för komplikationer samt bakgrundsfaktorer och blodprover som kan förutsäga patienternas prognos. Vi har bedömt tidigare studier av nedkylning i en systematisk översikt och lagt samman data från dessa studier.
Resultat: Ungefär hälften av de som läggs in på intensivvårdsavdelning efter hjärtstopp utanför sjukhus är vid liv efter ett halvår och få har bestående allvarliga hjärnskador. Tid till start av nedkylning och tid att nå måltemperaturen var inte relaterat till patienternas prognos. Hjärnskademarkören neuronspecifikt enolas var bättre än S-100 på att förutsäga prognos. Lunginflammation och andra infektioner, kramper, hjärtrytmrubbningar och störningar i salt- och blodsockerbalans är vanliga efter hjärtstillestånd men endast långvarigt förhöjt blodsocker och behandlingskrävande kramper var förenat med ökad dödlighet. Risken för komplikationer efter införandet av nedkylning ter sig vara jämförbart med riskerna innan nedkylning infördes, men direkta jämförelser är osäkra. I den systematiska översikten ser vi att tidigare studier ej håller tillräckligt hög kvalitet för att vi skall kunna vara förvissade om nedkylningens effekter.
Slutsats: Ungefär hälften av hjärtstoppspatienterna som behandlas på intensivvårdsavdelning med nedkylning överlever och få har bestående hjärnskador. Kortare tid till start av nedkylning och måltemperatur är inte förenat med ökad överlevnad med god funktion. Bevisläget för nedkylning är relativt svagt och förnyade studier behövs. Vi föreslår och har fått etiskt godkännande för en stor studie av nedkylning med 850 patienter som drabbats av hjärtstopp utanför sjukhus. Vår förhoppning är att resultaten skall medföra att fler patienter får optimal vård.

Originalspråk	engelska
Kvalifikation	Doktor
Tilldelande institution	Anestesiologi och intensivvård
Handledare	Friberg, Hans, handledare Herlitz, Johan, handledare, Extern person Wetterslev, Jørn, handledare, Extern person
Tilldelningsdatum	2010 maj 7
Förlag	Lund University
ISBN (tryckt)	978-91-86443-62-7
Status	Published - 2010

Bibliografisk information

Defence details

Date: 2010-05-07
Time: 13:00
Place: Lund University, BMC, Segerfalksalen

External reviewer(s)

Name: Callaway, Clifton
Title: MD, PhD
Affiliation: University of Pittsburgh

---

Ämnesklassifikation (UKÄ)

Anestesi och intensivvård

Tillgång till dokument

Nielsen

3 Artikel i vetenskaplig tidskrift

Neuron specific enolase and S-100B as predictors of outcome after cardiac arrest and induced hypothermia.
Rundgren, M., Karlsson, T., Nielsen, N., Cronberg, T., Johnsson, P. & Friberg, H., 2009, I: Resuscitation. 80, s. 784-789
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest.
Nielsen, N., Hovdenes, J., Nilsson, F., Rubertsson, S., Stammet, P., Sunde, K., Valsson, F., Wanscher, M. & Friberg, H., 2009, I: Acta Anaesthesiologica Scandinavica. 53, s. 926-934
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
Successful resuscitation with mechanical CPR, therapeutic hypothermia and coronary intervention during manual CPR after out-of-hospital cardiac arrest
Nielsen, N., Sandhall, L., Schersten, F., Friberg, H. & Olsson, S., 2005, I: Resuscitation. 65, 1, s. 111-113
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

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@phdthesis{649744949b07478ab8be440784bae252,

title = "Induced hypothermia after cardiac arrest",

abstract = "This thesis is based on studies of the clinical use of induced hypothermia as an intervention to reduce mortality and neurological impairment after cardiac arrest. After the publication of two trials indicating benefit of induced hypothermia, we developed a registry to assess outcome, possible adverse events and conduct of induced hypothermia when this intervention was implemented in a clinical population of cardiac arrest patients. Approximately half of the patients admitted to intensive care after out-of-hospital cardiac arrest survive and few patients have severe residual neurological impairment. The timing of hypothermia (early versus late induction of hypothermia and achievement of target temperature) was not associated to outcome. Adverse events were common, but only sustained hyperglycaemia and anticonvulsants administered for seizures were associated with increased mortality. Bleeding and infections were more common for patients having invasive procedures performed, but these adverse events were not associated with increased mortality. In a study of biomarkers of brain damage, neuron specific enolase was superior to S-100B as a predictor of a poor outcome. In a systematic review with meta-analyses and trial sequential analyses we conclude that the accumulated evidence for induced hypothermia is associated with substantial risks of systematic errors and the quality of the evidence is low. Trial sequential analyses indicate that the required information size to establish firm conclusions is not yet reached. Thus, we still do not know if induced hypothermia is beneficial, neutral or harmful for cardiac arrest patients Accordingly, clinical equipoise exists with respect to induced hypothermia and we therefore propose a randomised trial with the design based on the findings in this thesis.",

keywords = "complications, evidence, neurological outcome, survival, induced hypothermia, cardiac arrest, randomised trial, heart arrest",

author = "Niklas Nielsen",

note = "Defence details Date: 2010-05-07 Time: 13:00 Place: Lund University, BMC, Segerfalksalen External reviewer(s) Name: Callaway, Clifton Title: MD, PhD Affiliation: University of Pittsburgh ---",

year = "2010",

language = "English",

isbn = "978-91-86443-62-7",

series = "Lund University Faculty of Medicine Doctoral Dissertation Series ",

publisher = "Lund University",

type = "Doctoral Thesis (compilation)",

school = "Anesthesiology and Intensive Care",

}

TY - THES

T1 - Induced hypothermia after cardiac arrest

AU - Nielsen, Niklas

N1 - Defence details Date: 2010-05-07 Time: 13:00 Place: Lund University, BMC, Segerfalksalen External reviewer(s) Name: Callaway, Clifton Title: MD, PhD Affiliation: University of Pittsburgh ---

PY - 2010

Y1 - 2010

N2 - This thesis is based on studies of the clinical use of induced hypothermia as an intervention to reduce mortality and neurological impairment after cardiac arrest. After the publication of two trials indicating benefit of induced hypothermia, we developed a registry to assess outcome, possible adverse events and conduct of induced hypothermia when this intervention was implemented in a clinical population of cardiac arrest patients. Approximately half of the patients admitted to intensive care after out-of-hospital cardiac arrest survive and few patients have severe residual neurological impairment. The timing of hypothermia (early versus late induction of hypothermia and achievement of target temperature) was not associated to outcome. Adverse events were common, but only sustained hyperglycaemia and anticonvulsants administered for seizures were associated with increased mortality. Bleeding and infections were more common for patients having invasive procedures performed, but these adverse events were not associated with increased mortality. In a study of biomarkers of brain damage, neuron specific enolase was superior to S-100B as a predictor of a poor outcome. In a systematic review with meta-analyses and trial sequential analyses we conclude that the accumulated evidence for induced hypothermia is associated with substantial risks of systematic errors and the quality of the evidence is low. Trial sequential analyses indicate that the required information size to establish firm conclusions is not yet reached. Thus, we still do not know if induced hypothermia is beneficial, neutral or harmful for cardiac arrest patients Accordingly, clinical equipoise exists with respect to induced hypothermia and we therefore propose a randomised trial with the design based on the findings in this thesis.

AB - This thesis is based on studies of the clinical use of induced hypothermia as an intervention to reduce mortality and neurological impairment after cardiac arrest. After the publication of two trials indicating benefit of induced hypothermia, we developed a registry to assess outcome, possible adverse events and conduct of induced hypothermia when this intervention was implemented in a clinical population of cardiac arrest patients. Approximately half of the patients admitted to intensive care after out-of-hospital cardiac arrest survive and few patients have severe residual neurological impairment. The timing of hypothermia (early versus late induction of hypothermia and achievement of target temperature) was not associated to outcome. Adverse events were common, but only sustained hyperglycaemia and anticonvulsants administered for seizures were associated with increased mortality. Bleeding and infections were more common for patients having invasive procedures performed, but these adverse events were not associated with increased mortality. In a study of biomarkers of brain damage, neuron specific enolase was superior to S-100B as a predictor of a poor outcome. In a systematic review with meta-analyses and trial sequential analyses we conclude that the accumulated evidence for induced hypothermia is associated with substantial risks of systematic errors and the quality of the evidence is low. Trial sequential analyses indicate that the required information size to establish firm conclusions is not yet reached. Thus, we still do not know if induced hypothermia is beneficial, neutral or harmful for cardiac arrest patients Accordingly, clinical equipoise exists with respect to induced hypothermia and we therefore propose a randomised trial with the design based on the findings in this thesis.

KW - complications

KW - evidence

KW - neurological outcome

KW - survival

KW - induced hypothermia

KW - cardiac arrest

KW - randomised trial

KW - heart arrest

M3 - Doctoral Thesis (compilation)

SN - 978-91-86443-62-7

T3 - Lund University Faculty of Medicine Doctoral Dissertation Series

PB - Lund University

ER -

Induced hypothermia after cardiac arrest

Sammanfattning

Bibliografisk information

Ämnesklassifikation (UKÄ)

Tillgång till dokument

Fingeravtryck

Forskningsoutput

Neuron specific enolase and S-100B as predictors of outcome after cardiac arrest and induced hypothermia.

Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest.

Successful resuscitation with mechanical CPR, therapeutic hypothermia and coronary intervention during manual CPR after out-of-hospital cardiac arrest

Citera det här