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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Immune system activation has implications for cerebrovascular health, but little is known about the function of the immune system after a major cerebrovascular event, such as cardiac arrest and cardiopulmonary resuscitation (CA/CPR). Cardiac arrest and cardiopulmonary resuscitation damages the hippocampus, an important component of the hypothalamic-pituitary-adrenal (HPA) axis, and alterations in HPA axis activity can affect immune function. We tested the hypothesis that CA/CPR (approximately 8 mins) would cause HPA axis dysregulation and alter the delayed type hypersensitivity (DTH) response to antigenic challenge. We also assessed the primary and secondary antibody response of mice exposed to CA/CPR. Of the mice exposed to CA/CPR, half had brains protected by hypothermia to isolate the effects of the CA/CPR procedure from the effects of CA/CPR-induced neuronal damage. Cardiac arrest and cardiopulmonary resuscitation-induced neuronal damage resulted in a persistent elevation of blood corticosterone concentration and a concomitant augmentation of the DTH response to antigenic challenge. Furthermore, immune activation before CA/CPR decreased survival after global ischemia. These data highlight the potential impact of neuronal damage on cell-mediated immune function and the role of humoral immune activation in outcome after global ischemia.
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PMID:Cardiac arrest/cardiopulmonary resuscitation augments cell-mediated immune function and transiently suppresses humoral immune function. 1587 72

Hypothermia < 28 degrees C is rarely compatible with life, with only a few cases described surviving such low temperatures. We present a case of a man who survived with a core body temperature below 21.0 degrees C after spending a night in a snowbank with an ambient temperatures as low as -20.0 degrees C. Prolonged CPR and early initiation of extracorporeal membrane oxygenation enabled survival without neurological deficit at hospital discharge. Frostbite was limited to both hands and all toes only; although the entire upper and lower extremity appeared to be deeply frozen on admission, amputation of both hands was inevitable and resulted in permanent disability.
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PMID:One night in a snowbank: a case report of severe hypothermia and cardiac arrest. 1591 75

In emergency medicine accidental hypothermia (<35 degrees C) is a common epiphenomenon of many medical conditions. In contrast, severe hypothermia (<28 degrees C) occurs very seldom and presents a difficult medical situation. Here we present a female patient with severe urban hypothermia (core temperature of 20.7 degrees C) and circulatory arrest. An overview of the emergency treatment, rewarming strategy with extracorporeal circulation and the clinical course will be given. The survival of the patient and the favorable neurological outcome will be discussed considering the current literature. Due to the paucity of treatment guidelines or clear prognostic criteria of withholding or withdrawing treatment in severe hypothermia, the decision of prolonged resuscitation and rewarming strategy is solely dependent on the individual judgement and medical experience of the physician. The positive clinical outcome which can be gleaned from case reports or single retrospective studies should encourage the emergency physician to selectively rewarm a severe hypothermic patient with extracorporeal circulation under prolonged CPR.
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PMID:[Accidental urban hypothermia. Severe hypothermia of 20.7 degrees C]. 1599 56

In winter, French Medicalised Ambulance Service rescued a 50-year-old patient after suicide attempts by jump from a bridge in the Seine. The body was discovered after more than 10 minutes of immersion. She was unconscious and in deep hypothermia with circulatory arrest. Basic CPR was started immediately and oral intubation and 100% oxygen ventilation was performed. Ventricular fibrillation appeared but repeated defibrillation failed due to profound hypothermia (rectal temperature: 28 degrees C). The patient was immediately transported to hospital. CPR and mechanical ventilation was continued during transport. The patient was taken in emergency room. The oesophageal temperature was 22 degrees C. Rewarming using extracorporeal circulation was immediately initiated after insertion of femoral access. At 27 degrees C, ventricular fibrillation started and was converted by external defibrillation to a pulse-generating cardiac rhythm. At 360 minutes, the patient's rectal temperature had reached 36 degrees C and she was disconnected from cardiopulmonary bypass with inotropic support. She was transferred to the intensive care unit after 9 hours of resuscitation, rewarming and stabilisation. Mechanical ventilation was needed for 15 days because of adult respiratory distress syndrome. Renal failure, pneumonia also occurred. She was successfully extubated on day 15 and was discharged from intensive care unit on day 21, suffering no neurological side effects.
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PMID:[Resuscitation from accidental hypothermia of 22 degrees C with circulatory arrest: importance of prehospital management]. 1651 35

The new CPR guidelines are based on a scientific consensus which was reached by 281 international experts. Chest compressions (100/min, 4-5 cm deep) should be performed in a ratio of 30:2 with ventilation (tidal volume 500 ml, Ti 1 s, FIO2 if possible 1.0). After a single defibrillation attempt (initially biphasic 150-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min. Endotracheal intubation is the gold standard; other airway devices may be employed as well depending on individual skills. Drug administration routes for adults and children: first choice IV, second choice intraosseous, third choice endobronchial [epinephrine dose 2-3x (adults) or 10x (pediatric patients) higher than IV]. Vasopressors: 1 mg epinephrine every 3-5 min IV. After the third unsuccessful defibrillation attempt amiodarone IV (300 mg); repetition (150 mg) possible. Sodium bicarbonate (1 ml/kg 8.4%) only in excessive hyperkalemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider atropine (3 mg) and aminophylline (5 mg/kg). Thrombolysis during spontaneous circulation only in myocardial infarction or massive pulmonary embolism; during CPR only during massive pulmonary embolism. Cardiopulmonary bypass only after cardiac surgery, hypothermia or intoxication. Pediatrics: best improvement in outcome by preventing cardiocirculatory collapse. Alternate chest thumps and chest compression (infants), or abdominal compressions (>1-year-old) in foreign body airway obstruction. Initially five breaths, followed by chest compressions (100/min; approximately 1/3 of chest diameter): ventilation ratio 15:2. Treatment of potentially reversible causes (4 "Hs", "HITS": hypoxia, hypovolemia, hypo- and hyperkaliemia, hypothermia, cardiac tamponade, intoxication, thrombo-embolism, tension pneumothorax). Epinephrine 10 microg/kg IV or intraosseously, or 100 microg (endobronchially) every 3-5 min. Defibrillation (4 J/kg; monophasic oder biphasic) followed by 2 min CPR, then ECG and pulse check. Newborns: inflate the lungs with bag-valve mask ventilation. If heart rate<60/min chest compressions:ventilation ratio 3:1 (120 chest compressions/min). Postresuscitation phase: initiate mild hypothermia [32-34 degrees C for 12-24 h; slow rewarming (<0.5 degrees C/h)]. Prediction of CPR outcome is not possible at the scene; determining neurological outcome within 72 h after cardiac arrest with evoked potentials, biochemical tests and physical examination. Even during low suspicion for an acute coronary syndrome, record a prehospital 12-lead ECG. In parallel to pain therapy, aspirin (160-325 mg PO or IV) and in addition clopidogrel (300 mg PO). As antithrombin, heparin (60 IU/kg, max. 4000 IU) or enoxaparine. In ST-segment elevation myocardial infarction, define reperfusion strategy depending on duration of symptoms until PCI (prevent delay>90 min until PCI). Stroke is an emergency and needs to be treated in a stroke unit. A CT scan is the most important evaluation, MRT may replace a CT scan. After hemorrhage exclusion, thrombolysis within 3 h of symptom onset (0.9 mg/kg rt-PA IV; max 90 mg within 60 min, 10% of the entire dosage as initial bolus, no aspirin, no heparin within the first 24 h). In severe hemorrhagic shock, definite control of bleeding is the most important goal. For successful CPR of trauma patients, a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation, and excessive ventilation pressure may impair outcome in severe hemorrhagic shock. Despite bad prognosis, CPR in trauma patients may be successful in select cases. Any CPR training is better than nothing; simplification of contents and processes remains important.
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PMID:[The new 2005 resuscitation guidelines of the European Resuscitation Council: comments and supplements]. 1691 4

Neurologic injury is the predominant cause of poor functional outcome in patients who are resuscitated from cardiac arrest. The management of these patients in the ICU can be challenging because of the paucity of effective therapies and lack of readily available diagnostic and prognostic tools. After several decades of failed pharmacologic neuroprotection trials, recent and well-designed randomized trials showed that therapeutic hypothermia is an effective neuroprotective measure in comatose survivors of cardiac arrest. Therapeutic hypothermia has been recommended by the International Liaison Committee on Resuscitation and has been incorporated in the American Heart Association CPR Guidelines. The American Academy of Neurology recently enhanced the delivery of care in survivors of cardiac arrest by providing evidence-based practice parameters on the prediction of poor outcome in comatose survivors of cardiac arrest, based on clinical evaluation and diagnostic tests. This article discusses these advances and their potential impact on the care provided in the ICU.
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PMID:Intensive care for brain injury after cardiac arrest: therapeutic hypothermia and related neuroprotective strategies. 1723 47

In a recent issue of Critical Care, Mally and colleagues reported outcomes from an observational study of out-of-hospital cardiac arrests in Slovenia. Multivariable analysis identified independent predictors for hospital discharge, including higher end-tidal carbon dioxide (ETCO2) levels, higher mean arterial pressure (MAP) and the recency (years) of the arrest. ETCO2 has been previously demonstrated to correlate with cardiac index, and predict successful resuscitation. Initial ETCO2 reflects the initial adequacy of resuscitation, and the ETCO2 on admission to hospital reflects a number of factors, including the adequacy of ventilation. During resuscitation, coronary perfusion pressure appears important for survival, but there are limited human data to guide hemodynamic management after cardiac arrest. A higher blood pressure could represent more vasoconstriction, less vasodilation, avoidance of hyperventilation, or a better cardiac output. Improved hospital discharge was also observed during the later years of the study. During this period a number of factors could have contributed to the improved outcome. These include new guidelines, the awareness of the importance of good CPR (including avoidance of hyperventilation), and better post-resuscitation care (including therapeutic hypothermia). It is hard to unravel the actual contribution of these factors to the final outcome, but the authors should be commended for their excellent overall results, and their thought provoking manuscript.
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PMID:Improved cardiac arrest outcomes: as time goes by? 1737 25

Two men, 56 and 33 years old, (case 1 and case 2) were examined neuropsychologically after successful resuscitation from circulatory arrest following extreme accidental hypothermia and near drowning. After submersion in ice water for at least 20 minutes they received CPR for 45 to 60 minutes. Body-core temperature at start of CPB was 24 degrees C and 22 degrees C, respectively. A neuropsychological examination was performed within two months after the accident and 1 year later. An additional follow-up interview was made 3 years after the accidents. Both had severe problems with memory, visuospatial performance, executive function, and verbal fluency. The follow-up demonstrated improvement in the visuospatial test in both and in the verbal learning, recall, and logical reasoning tests in case 2. Both still had problems with executive function, and case 2 also in verbal fluency. Case 1 also had problems with flexibility, planning and abstract ability. Despite the protective effects of hypothermia and gradual improvement of symptoms over time, some of the deficits were permanent. A thorough neuropsychological examination of patients suffered from anoxia is advisable, because gross neurological examination and MRI scans may not always reveal underlying brain dysfunction.
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PMID:Neuropsychological outcome following near-drowning in ice water: two adult case studies. 1857 96

Cardiac arrest in infants and children is a rare but critical event that typically follows a period of respiratory or circulatory compromise and has a low survival rate. The only intervention demonstrated to increase survival rate is the provision of bystander CPR. This article examines the pathophysiology of the postarrest reperfusion state; postresuscitation care of the respiratory and cardiovascular systems; postresuscitation neurologic management; therapeutic hypothermia; blood glucose control; immunologic disturbances and infections; coagulation abnormalities; and gastrointestinal and hepatic dysfunction, among other topics.
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PMID:Postresuscitation care. 1867 28

Cervical-spine injury, trauma, and hypothermia should be considered in all sports-related near-drownings. The focus of resuscitation should be on prompt restoration of respiration, CPR, and advanced cardiac life support with cervical-spine precautions. A subset of near-drowning victims can be discharged after only 4 to 6 hours of observation. Although total drowning deaths have decreased 45% in the past 15 years, a greater emphasis on public education to prevent drowning remains in order.
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PMID:Near-drowning: life-saving steps. 2008 31


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