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Therapeutische Hypothermie nach Herz-Kreislaufstillstand

Eine kombinierte Kühlmethode zum schnellstmöglichen Erreichen der Zieltemperatur

Induction of therapeutic mild hypothermia after cardiac arrest: A combined method to achieve the target temperature

  • ORIGINALARBEIT
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Intensivmedizin und Notfallmedizin

Abstract

Clinical and experimental investigations have demonstrated, that induction of mild hypothermia following successful cardiopulmonal resuscitation (CPR) improves neurological outcome. Time course and duration to achieve target temperature are important factors that influence patient's outcome. In these patients important time for induction of therapeutic hypothermia will be lost by additional diagnostics, e.g. in heart catheter laboratory. Here we test a combined method to achieve target temperature for induction of therapeutic hypothermia after cardiac arrest. A total of 50 patients were examined after successful CPR. Twenty-nine patients received 4 °C cold infusions after arrival in the heart catheter laboratory. Retrospective data of twenty-one patients who received a volume substitute by means of drips at ambient temperature served as a control group. After admission to the ICU, both groups were immediately connected to an cooling device and were cooled to a target temperature of 33 °C (bladder temperature). The average temperature at admission did not differ in the two groups (35.5 ± 0.9 °C vs 35.89 ± 0.8 °C). In the group with initial cooling following 4 °C cold infusions, a significant temperature decrease could be reached during the invasive coronary diagnostics prior to admission to the ICU. Average chill duration to achieve the target temperature after admission was significantly shorter with the combined method. The period needed to achieve the target temperature after the beginning of the external cooling device with the group of the combined method was significantly shorter. The combined method with initial cooling with 4 °C cold solutions shows a very effective prestationary cooling procedure to introduce and realize mild hypothermia and offers the possibility to reach desired temperature significantly faster. Preclinical introduction of mild hypothermia by means of 4 °C cold solutions could be a beneficial step in the future treatment and probably affects the outcome of these patients

Zusammenfassung

Klinische und experimentelle Untersuchungen konnten zeigen, dass nach erfolgreicher kardiopulmonaler Reanimation die Induktion einer milden Hypothermie neuroprotektiv wirkt. Einen wesentlichen Faktor für den Kühlerfolg stellt der Zeitraum bis zum Erreichen der Zieltemperatur dar. Bei Patienten mit einem primär kardialen Ereignis, welche initial über das Herzkatheterlabor versorgt werden, geht hiermit wertvolle Zeit verloren. Wir berichten über eine kombinierte Kühlmethode, bei der die Patienten unmittelbar nach Aufnahme im Herzkatheterlabor mittels 4°C kalten Infusionen und anschließend nach Ankunft auf der Intensivstation mit einem konventionellen Kühlsystem versorgt wurden im Vergleich zu Patienten ohne primärer Kühlung im Herzkatheterlabor. Die durchschnittliche Temperatur bei Aufnahme war bei beiden Gruppen gleich (35,5 ± 0,9 °C vs. 35,89 ± 0,8 °C). Die mittlere Kühldauer zum Erreichen der Zieltemperatur nach Aufnahme war bei der kombinierten Kühlmethode signifikant kürzer. Ebenso war der Zeitraum zum Erreichen der Zieltemperatur nach Aufnahme auf der Intensivstation bei der kombinierten Kühlmethode signifikant kürzer. Nach Infusion 4 °C kalter Infusionslösungen traten keine vermehrten Nebenwirkungen auf. Die kombinierte Kühlmethode mit initialer Kühlung von 4 °C kalten Infusionslösungen und anschließender konventioneller Kühlung stellt ein sicheres und sehr effektives prästationäres Kühlverfahren zur Durchführung einer milden Hypothermie dar. Mit diesem Verfahren kann die Zieltemperatur ohne das Auftreten von Nebenwirkungen signifikant schneller erreichen werden. Aufgrund der schon prästationären Induktion der milden Hypothermie vor der Intensivaufnahme kann die kostenintensive und pflegeaufwendige Kühlphase deutlich verkürzt werden.

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Correspondence to Hans-Jörg Busch.

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Busch, HJ., Fink, K., Bode, C. et al. Therapeutische Hypothermie nach Herz-Kreislaufstillstand. Intensivmed 45, 82–88 (2008). https://doi.org/10.1007/s00390-008-0847-5

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  • DOI: https://doi.org/10.1007/s00390-008-0847-5

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