Case reportTherapeutic hypothermia induced during cardiopulmonary resuscitation using large-volume, ice-cold intravenous fluid☆
Introduction
Treatment with mild hypothermia (33 °C) induced after cardiopulmonary resuscitation (CPR) is recommended for treatment of neurological injury following prolonged out-of-hospital cardiac arrest,1, 2 based on the findings of two randomised, controlled clinical trials.3, 4 However, the optimal timing and technique of induction of hypothermia remain uncertain. Laboratory studies in animal models have suggested that outcomes may be further improved if hypothermia is induced during CPR.5, 6
One possible technique for the induction of hypothermia during CPR is a rapid intravenous infusion (>100 mL/min) of large-volume (40 mL/kg), ice-cold (4 °C) crystalloid fluid (LVICF). Preliminary clinical experience with LVICF after CPR suggests that this approach decreases core temperature without pulmonary oedema.7, 8, 9, 10, 11 Unlike surface cooling, this treatment would be feasible if given during CPR, however there have been no previous reports of this treatment. Here, we report the case of a patient who had therapeutic hypothermia induced using LVICF during prolonged CPR to provide neurological protection.
Section snippets
Case report
A 60-year-old 72 kg female was admitted for investigation of hypoxaemia. Three weeks earlier, the patient had undergone right upper lobectomy for carcinoma. The post-operative care had been complicated by persistent pulmonary infection and mild hypoxaemia. The patient was discharged to a sub-acute care facility on day 14. However, the hypoxaemia persisted and the patient was readmitted to hospital for further investigation.
A number of investigations to evaluate the cause of hypoxaemia were
Discussion
This case is the first clinical report of hypothermia induced during CPR using a rapid infusion (150 mL/min) of large-volume (40 mL/kg), ice-cold crystalloid fluid in a patient with prolonged cardiac arrest. The duration of the cardiac arrest was reliably documented as 37 min, with no external chest compressions performed for at least 10 min of the arrest during attempts at percutaneous needle drainage. This duration of cardiac arrest would be expected to cause significant neurological injury.
Conflict of interest
None.
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Cited by (37)
Prehospital therapeutic hypothermia after out-of-hospital cardiac arrest: a systematic review and meta-analysis
2016, American Journal of Emergency MedicineCitation Excerpt :Animal studies proved that initiating hypothermia during CPR was better than cooling after ROSC for both survival and neurological outcomes [8,23]. A case report showed that using ice-cold fluid during cardiopulmonary resuscitation decreased body temperature and provided neurological protection [24]. Second, the optimal target temperature was not achieved by prehospital cooling because of the short transport time and limited cold liquid.
Part 8: Advanced life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :One study indicated that ED thoracotomy may be especially beneficial if gross blood causes clotting and blocking of a pericardiocentesis needle (LOE 2).716 Two studies indicated that emergency thoracotomy may also be beneficial in patients who have postprocedure complications (LOE 4).682,717 One study indicated that a more definitive sternotomy or thoracotomy in an operating room may also be beneficial if transportation to the operating room does not introduce significant delay (LOE 5).718
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2010, Medicina IntensivaCardio-respiratory reanimation: The brain is the target organ
2010, Current Anaesthesia and Critical CareTherapeutic hypothermia for heart attack: Yes, we can
2009, Revista Espanola de Cardiologia
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.07.017.