RESUMEN
OBJECTIVE: Hypothermia has been shown to reduce neurologic deficits in patients after cardiopulmonary resuscitation (CPR). It was not clear if intravascular cooling is superior to standard external cooling in inducing hypothermia. Goal of this study was to compare intravascular cooling with an automated cooling device with external cooling in everyday practice on a cardiac-care ICU (intensive care unit). METHODS: Patients after successful CPR for unwitnessed cardiac arrest were subjected to cooling with an automated cooling system (CoolGard, Alsius) after initial hemodynamic stabilization. Goal was to achieve a core temperature of 33 degrees C. Monitored were the time intervals from admission to begin of cooling and from begin of cooling to target temperature. Data were compared retrospectively with those from patients subjected to external cooling. RESULTS: 31 consecutive patients treated with intravascular cooling were analyzed. Cooling was initiated at a mean time of 58 min after admission, and the target temperature of 33 degrees C was achieved after a mean of 3.48 hours after the begin of cooling. In contrast, 49 patients treated with external cooling achieved a minimum temperature of 34.8 degrees C only 9.2 hours after admission. CONCLUSION: In everyday practice, intravascular cooling using an automated cooling system is superior for a rapid induction of hypothermia after cardiac arrest.
RESUMEN
BACKGROUND: Therapeutic hypothermia can improve survival after cardiopulmonary resuscitation (CPR). Coenzyme Q10 (CoQ10) has shown a protective effect in neurodegenerative disorders. We investigated whether combining mild hypothermia with CoQ10 after out-of-hospital cardiac arrest provides additional benefit. METHODS AND RESULTS: Forty-nine patients were randomly assigned to either hypothermia plus CoQ10 or hypothermia plus placebo after CPR. Hypothermia with a core temperature of 35 degrees C was instituted for 24 hours. Liquid CoQ10 250 mg followed by 150 mg TID for 5 days or placebo was administered through nasogastric tube. Age, sex, premorbidity, cause of arrest, conditions of CPR, and degree of hypoxia were similar in both groups; no side effects of CoQ10 were identified. Three-month survival in the CoQ10 group was 68% (17 of 25) and 29% (7 of 24) in the placebo group (P=0.0413). Nine CoQ10 patients versus 5 placebo patients survived with a Glasgow Outcome Scale of 4 or 5. Mean serum S100 protein 24 hours after CPR was significantly lower in the CoQ10 group (0.47 versus 3.5 ng/mL). CONCLUSIONS: Combining CoQ10 with mild hypothermia immediately after CPR appears to improve survival and may improve neurological outcome in survivors.