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Endovascular cooling improves neurological short-term outcome after prehospital cardiac arrest

Endovaskuläre Kühlung verbessert das frühe neurologische Ergebnis nach prähospitalem Herz-Kreislauf-Stillstand

Intensivmedizin und Notfallmedizin

Zusammenfassung

Der Einsatz milder Hypothermie nach prähospitalem Herz-Kreislauf-Stillstand verbessert das neurologische Ergebnis dieser Patienten. Ein gängiges Verfahren zur Induktion milder Hypothermie ist die Oberflächenkühlung mittels Eispacks. Eine neuere Methode stellt die endovaskuläre Kühlung dar, die sich als sicher und praktikabel erwiesen hat. Ob sich aufgrund präziserer Temperaturkontrolle unter klinischen Alltagsbedingungen mit diesem Verfahren bessere neurologische Frühergebnisse erzielen lassen, untersuchten wir retrospektiv an 39 Patienten nach prähospitalem Herz-Kreislauf-Stillstand.

Die Kühlung erfolgte entweder mit Hilfe eines endovaskulären Systems (n=19, Gruppe 1) oder mittels Applikation von Eispacks (n=20, Gruppe 2) für jeweils 24 h. Die Zieltemperatur betrug 33 °C in Gruppe 1 und 32–34 °C in Gruppe 2. Verglichen wurden die Effektivität der Kühlung sowie das neurologische Ergebnis anhand der cerebral performance category (CPC) zum Zeitpunkt der Krankenhausentlassung.

Die Basischarakteristika der Patientengruppen waren vergleichbar. Während der Hypothermiephase wurde die Zieltemperatur bei allen Patienten in Gruppe 1 erzielt, jedoch nur bei zwei Patienten in Gruppe 2 (p<0,001). Die mittlere Körperkerntemperatur betrug 32,9±0,1 °C in Gruppe 1 und 36,1±1,3 °C in Gruppe 2 (p<0,001). Bei Krankenhausentlassung hatten mehr Patienten in Gruppe 1 ein gutes neurologisches Ergebnis (47,4% CPC 1/2 in Gruppe 1 vs. 20,0% CPC 1/2 in Gruppe 2; p=0,08). In der Subgruppe der Nicht-Diabetiker war dieser Unterschied noch deutlicher (63,6% CPC 1/2 in Gruppe 1 vs. 23,1% CPC 1/2 in Gruppe 2; p=0,007).

Verglichen mit der Applikation von Eispacks zur Induktion milder Hypothermie nach prähospitalem Herz-Kreislauf-Stillstand verbessert die endovaskuläre Kühlung unter klinischen Alltagsbedingungen das frühe neurologische Ergebnis, insbesondere bei Nicht-Diabetikern. Dieser Effekt ist vornehmlich auf die deutlich verbesserte Effektivität dieses neueren Verfahrens zurückzuführen.

Abstract

Mild hypothermia following successful resuscitation from prehospital cardiac arrest has shown to improve patient's short-term neurological outcome. Usually, extracorporal methods are performed to achieve a core temperature of 32–34 °C. Recently, an endovascular cooling device has proven to be safe and feasible to induce mild hypothermia. Because of precise target temperature control in daily clinical routine, the endovascular method might lead to more favorable neurological outcomes than extracorporal cooling using cold packs.

We retrospectively studied 39 patients after prehospital cardiac arrest from various causes, who were treated with mild hypothermia for 24 h either by an endovascular cooling device (group 1; n=19) or by an extracorporal method (group 2; n=20) using cold packs. Target temperature was 33 °C in group 1 and 32-34 °C in group 2. The efficiacy of the cooling procedure and patient's neurological outcome (classified by cerebral performance category CPC) at the time of hospital discharge were compared between both groups.

Patient's baseline characteristics were comparable between both groups. During hypothermia, the target temperature was reached in all cases in group 1 but only in two cases in group 2 (p<0.001). Mean core temperature was 32.9±0.1 °C in group 1 and 36.1±1.3 °C in group 2 (p<0.001). At the time of hospital discharge, more patients in group 1 had a good neurological outcome (group 1 vs group 2, 47.4% CPC 1/2 vs 20.0% CPC 1/2; p=0.08). In the subgroup of nondiabetic patients, this difference was even more pronounced (group 1 vs group 2, 63.6% CPC 1/2 vs 23.1% CPC 1/2; p=0.007).

Compared to an extracorporal method using cold packs, endovascular cooling can improve neurological short-term outcome after prehospital cardiac arrest, especially in non-diabetics. This effect results from better target temperature control in daily clinical routine.

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Feuchtl, A., Gockel, B., Lawrenz, T. et al. Endovascular cooling improves neurological short-term outcome after prehospital cardiac arrest. Intensivmed 44, 37–42 (2007). https://doi.org/10.1007/s00390-007-0740-7

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  • DOI: https://doi.org/10.1007/s00390-007-0740-7

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