Hyperthermia: is it an ominous sign after cardiac arrest?
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)
- et al.
Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury
Mayo Clin. Proc.
(1998) - et al.
Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest
Resuscitation
(1998) - et al.
Brain-oriented intensive care after resuscitation from cardiac arrest
Resuscitation
(1992) - et al.
Temperature changes of ⩾1 degree alter functional neurologic outcome and histopathology in a canine model of complete cerebral ischemia
Anesthesiology
(1995) - et al.
The effect of mild hyperthermia and hypothermia on brain damage following 5, 10, and 15 min of forebrain ischemia
Ann. Neurol.
(1990) - et al.
Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury
J. Cereb. Blood Flow Metab.
(1987) - et al.
Long-lasting neuroprotective effect of postischemic hypothermia and treatment with an anti-inflammatory/antipyretic drug
Stroke
(1996)