Victims Of Sudden Cardiac Arrest Can Often Be Saved By Therapeutic Hypothermia

Victims Of Sudden Cardiac Arrest Can Often Be Saved By Therapeutic Hypothermia.


For kith and kin plagued with sudden cardiac arrest, doctors often place to turn to a brain-protecting "cooling" of the body, a procedure called therapeutic hypothermia. But late research suggests that physicians are often too quick to terminate potentially lifesaving supportive care when these patients' brains be to "re-awaken" after a standard waiting period of three days read this. The probing suggests that these patients may need care for up to a week before they regain neurological alertness.



And "Most patients receiving normal care - without hypothermia - will be neurologically awake by day 3 if they are waking up," explained the go first author of one study, Dr Shaker M Eid, an second professor of medicine at Johns Hopkins University School of Medicine. However, in his team's study, "patients treated with hypothermia took five to seven days to path up" source. The results of Eid's bookwork and two others on therapeutic hypothermia were scheduled to be presented Saturday during the conclave of the American Heart Association in Chicago.



For over 25 years, the prognosis for salvage from cardiac arrest and the decision to withdraw care has been based on a neurological exam conducted 72 hours after incipient treatment with hypothermia, Eid pointed out. The new findings may sling doubt on the wisdom of that approach.



For the Johns Hopkins report, Eid and colleagues planned 47 patients who survived cardiac arrest - a sudden loss of heart function, often tied to underlying goodness disease. Fifteen patients were treated with hypothermia and seven of those patients survived to nursing home discharge. Of the 32 patients that did not receive hypothermia therapy, 13 survived to discharge.



Within three days, 38,5 percent of patients receiving orthodox disquiet were alert again, with only mild mental deficits. However, at three days none of the hypothermia-treated patients were cautious and conscious.



But things were different at the seven-day mark: At that point, 33 percent of hypothermia-treated patients were on guard and had only mild deficits. And by the time of their hospital discharge, 83 percent of the hypothermia-treated patients were lookout and had only mild deficits, the researchers found. "Our evidence are preliminary, provocative but not robust enough to prompt change in clinical practice," Eid stated.



In the two shakes study, a team led by Dr Kyle McCarty, an emergency medicine resident at Maricopa Medical Center in Phoenix, found that withdrawing hypothermia before three days was proletarian even though it was counter to existing protocols. "Thus far we have found that in spite of the fact that current guidelines state that the neurological prognosis after cardiac seize cannot be reliably assessed within 72 hours of the completion of therapeutic hypothermia, the timing of withdrawal of solicitude after hypothermia is highly variable". In fact, "early withdrawal of care is familiar even in a system with specific protocols aimed at preventing early withdrawal".



Of the 177 patients studied, hypothermia worry was withdrawn from one-third of patients within 24 hours and close to one-third (30 percent) of patients within 25 to 72 hours. Only about one-quarter of the patients well-thought-out received therapeutical hypothermia for the recommended minimum of 72 hours, McCarty's team found. "This enquiry implies that even in a system with specific protocols set up to prevent early withdrawal of care in patients who have undergone corrective hypothermia, there is significant variability in the timing of care withdrawal, frequently prior to the recommended 72 hours".



And in the unchangeable study, Dr Keith Lurie, a professor of medicine at the University of Minnesota in Minneapolis, and colleagues found that withdrawing vital spark support 72 hours after re-warming "may rashly terminate life in at least 10 percent of all potentially neurologically intact survivors" of cardiac restrain treated with hypothermia. For the study, Lurie's team looked at the schedule from when patients had been fully "re-warmed" to when they showed signs of awakening - including being alert and oriented.



Among the 66 patients studied, six who showed signs of cognition re-awakening beyond the traditional 72-hour cut-off regained use neurological function within a month of the cardiac arrest. However, comatose patients were almost always treated after hypothermia for at least two days before any decision to withdraw care was made, the researchers noted.



Commenting on the studies, Dr Gregg Fonarow, American Heart Association spokesman and professor of cardiology at the University of California, Los Angeles, said that "therapeutic hypothermia for dead to the world cardiac-arrest survivors has been demonstrated to recuperate neurologic outcomes and self-possessed survival. As a result, this come nigh is being increasingly applied to individuals with out-of-hospital cardiac arrest".



These three new studies each suggest that significant neurologic saving may occur beyond 72 hours of re-warming, however. But, in some cases, premature withdrawal of vitality support within 72 hours after re-warming is still occurring, according to Fonarow.



Furthermore, "recent American Heart Association guidelines pomp that neurologic prognosis after out-of-hospital cardiac arrest cannot be reliably assessed within 72 hours of the termination of therapeutic hypothermia. Centers providing therapeutic hypothermia for patients with out-of-hospital cardiac catch need to pay close attention to these important new findings and confirm protocols consistent with current American Heart Association guidelines are being implemented and followed" home page. Experts characteristic out that research presented at meetings is not subjected to the same type of scrutiny given to research published in peer-reviewed journals.

tag : hypothermia patients cardiac hours arrest therapeutic treated withdrawal percent

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