Summary
Background
Recent studies have proven the positive effect of mild hypothermia (32–34 °C) on neurologic outcome in patients after cardiopulmonary resuscitation (CPR) due to ventricular fibrillation. Nevertheless, this method is generally not utilized. Here we report our initial experiences with the technical procedures, physiologic effects and complications involved with hypothermia through conduction and convection.
Patients and Methods
The data of 20 hospitalized patients who received mild hypothermic therapy following cardiopulmonary resuscitation were retrospectively evaluated.
Results
The target temperature of 33 °C was attained in 19 of 20 patients within 2 to maximally 5.4 hours. Relevant fluctuation of the body temperature was observed. In two patients significant hyperkalemia (> 6.0 mmol/l) occurred during the rewarming period and in one case the patient developed bradycardia, requiring acute therapeutic treatment.
Conclusions
Controlled mild hypothermia is a method that can be performed well on a medical intensive care unit. However, intensive monitoring of patients, in particular with regard to potassium levels, is necessary. Based on our experience there is no reason why mild hypothermic therapy should not be used in patients with a proper medical indication, even in intensive care stations without any special cooling technique.
Zusammenfassung
Hintergrund
Um das neurologische Outcome bei Patienten nach kardiopulmonaler Reanimation bei Kammerflimmern zu verbessern, hat sich zuletzt in mehreren klinischen Studien der Einsatz einer milden Hypothermie von 32–34 °C als effektiv gezeigt. Dennoch wird diese Methode noch nicht generell eingesetzt. Wir berichten hier über unsere ersten Erfahrungen mit der technischen Umsetzung, den physiologischen Effekten und den aufgetretenen Komplikationen der Hypothermie durch Konduktion und Konvektion.
Patienten und Methodik
Retrospektiv wurden die Krankenunterlagen der ersten 20 Patienten (9 Frauen, 11 Männer) bei denen eine milde Hypothermietherapie nach Reanimation durchgeführt wurde ausgewertet.
Ergebnisse:
Die Zieltemperatur von 33 °C konnte bei 19 von 20 Patienten innerhalb von 2 bis maximal 5,4 Stunden erreicht werden. Während der Hypothermiephase kam es zum Teil zu deutlichen Schwankungen der Körpertemperatur. Bei zwei Patienten traten relevante Hyperkaliämien (> 6,0 mmol/l) in der Wiedererwärmungsphase auf, in einem Fall kam es zu einer Hyperkaliämie bedingten behandlungsbedürftigen Bradykardie.
Schlussfolgerung
Die kontrollierte milde Hypothermie durch Konduktion und Konvektion ist eine auf einer internistischen Intensivstation gut durchführbare und kostengünstige Methode. Ein engmaschiges Monitoring der Patienten ist insbesondere im Hinblick auf die Körpertemperatur und die Serum-Kaliumwerte notwendig. Unseren Erfahrungen nach gibt es keine Gründe, warum eine milde Hypothermie—auch auf Intensivstationen die über keine spezielle Kühltechnik verfügen—bei Patienten mit gegebener Indikation nicht generell durchgeführt werden sollte.
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Aberle, J., Kluge, S., Prohl, J. et al. Hypothermie nach Reanimation durch Konduktion und Konvektion. Intensivmed 43, 37–43 (2006). https://doi.org/10.1007/s00390-006-0635-z
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DOI: https://doi.org/10.1007/s00390-006-0635-z