Elsevier

Resuscitation

Volume 49, Issue 3, June 2001, Pages 273-277
Resuscitation

Hyperthermia: is it an ominous sign after cardiac arrest?

https://doi.org/10.1016/S0300-9572(00)00360-9Get rights and content

Abstract

Objective: To clarify the clinical characteristics of hyperthermia at an early stage after resuscitation from cardiac arrest (CA). Materials and methods: We reviewed the medical records of 43 adult patients with non-traumatic out-of-hospital CA, who survived for longer than 24 h after admission to our intensive care unit (ICU) between January, 1995, and December, 1998. The patients were divided into two groups: a clinical brain death (CBD) group (n=23) and a non-CBD group (n=20), and various factors relating to hyperthermia were compared between the two groups. Results: The mean value of peak axillary temperatures within 72 h of admission was 39.8±0.9°C for the CBD group, which was significantly greater than 38.3±0.6°C for the non-CBD group (P<0.0001). The time of occurrence of the peak axillary temperature was at 19±16 h of admission in the CBD group and 20±18 h in the non-CBD group (not significantly different). There were no significant differences in risk factors relating to the occurrence of hyperthermia between the two groups, except for the number of patients who received epinephrine at ICU. In 23 patients with a peak axillary temperature of ≧39°C during the first 72 h of hospitalization, brain death was diagnosed in 20 patients, whereas only 3 of 20 patients having a peak axillary temperature of <39°C developed brain death (odds ratio, 37.8; 95% confidence interval, 6.72–212.2). Conclusion: Hyperthermia at an early stage after resuscitation from CA may be associated with the outcome of brain death.

Sumàrio

Objectivo: Clarificar o significado clı&#x0301;nico da hipertermia no perı&#x0301;odo imediato após reanimação por paragem cardı&#x0301;aca (PC). Materiais e método: Foram revistos os registos médicos de 43 pacientes adultos vı&#x0301;timas de paragem cardı&#x0301;aca não traumática fora do Hospital, que sobreviveram mais de 24 h após a admissão na Unidade de Cuidados Intensivos (UCI) entre Janeiro de 1995 e Dezembro de 1998. Os doentes foram divididos em 2 Grupos: um grupo Morte Cerebral Clı&#x0301;nica (MCC) (n=23) e um Grupo Não-MCC (n=20), tendo-se comparado vários factores, relacionados com hipertermia, entre os 2 grupos. Resultados: O valor médio da temperatura axilar pico nas primeiras 72 h de admissão foi 39.8 ± 0.9°C para o grupo MCC, o que foi significativamente mais elevado do que 38.3 ± 0.6C para o grupo Não-MCC (p<0.0001). O tempo de ocorrência da temperatura axilar de pico foi às 19 ± 16 h de admissão no grupo MCC e às 20 ± 18 h no grupo Não-MCC (sem diferença significativa). Não existiam diferenças significativas entre os dois grupos nos factores de risco para a ocorrência de hipertermia, excepto o número de doentes que receberam epinefrina na UCI. Nos que desenvolveram temperatura axilar de pico ≧39°C nas primeiras 72 h pós hospitalização foi diagnosticada MCC em 20 doentes, ao passo que só 3 dos 20 que nas primeiras 72 h tiveram temperatura axilar < 39°C evoluiram para MCC (odds ratio 37.8; intervalo de confiança 95%, 6.72-212.2). Conclusão: A hipertermia, numa fase precoce após reanimação de PC, pode estar associada com o outcome de morte cerebral.

Introduction

In animal models of global or focal cerebral ischemia, post-ischemic outcome is adversely affected by an increase in body temperature [1], [2], [3], [4]. In clinical studies of patients with stroke, a fever seems to be associated with a worse outcome [5], [6]. Although hyperthermia is frequently observed at an early stage after resuscitation from cardiac arrest (CA) [7], the temperature profiles of post-CA patients have not been documented well. Our previous retrospective study showed the possibility that hyperthermia may affect the neurological prognosis of resuscitated post-CA patients [8]. The major limitation of that study was a small sample size.

The objective of the present study was to clarify the clinical characteristics of hyperthermia in the patients resuscitated from CA in a larger sample size than our previous study. In addition, we hypothesized that hyperthermia at an early stage after resuscitation from CA would be associated with a higher probability of brain death.

Section snippets

Materials and methods

Medical case records were retrospectively reviewed for the patients with non-traumatic out-of-hospital CA, who were admitted to our intensive care unit (ICU) after spontaneous circulation (ROSC) was restored at our emergency department (ED), during a period from January 1, 1995, to December 31, 1998. The patients who were at the age of 18 yr and older and survived more than 24 h after admission to ICU were included in this study. Patients who had therapeutic hypothermia were excluded. Patients’

Results

During the study, 130 non-traumatic out-of-hospital CA patients were admitted to our ICU. Out of them, 58 died within 24 h of admission because of progressive cardiovascular dysfunction and were not included in this study. Twenty nine patients who had received therapeutic hypothermia [9] were also excluded from this study. The enrollment into the therapeutic hypothermia protocol was dependent on the primary physician's decision and the enthusiasm of patients’ family. Thus, 43 of the 130

Discussion

This study demonstrated that, although hypothermia was common in out-of-hospital CA patients on their arrival at ED, hyperthermia occurred at an early stage after their hospitalization. More importantly, we found that the occurrence of a peak axillary temperature of ≧39°C for the first 72 h of hospitalization was associated with a higher incidence of CBD. These findings were totally consistent with findings in our previous study at a smaller scale [8].

The following factors, (a)–(d), are worth

References (15)

There are more references available in the full text version of this article.

Cited by (0)

View full text