Routine Laboratory Indices as Predictor of Neurological Recovery in Post-Resuscitation Syndrome Patients Treated with Therapeutic Hypothermia.

BACKGROUND: Hypothermia is associated with improved outcome in selected survivors of cardiac arrest but no single metric enables proper prediction of neurological outcome. OBJECTIVES: To explored the association between routine laboratory indices of patients treated by hypothermia for cardiac arrest and their neurological outcome. METHODS: We retrospectively collected data from survivors of cardiac arrest treated with hypothermia for 24 hours and grouped them according to their neurological outcome to either "poor" or "favorable". Routine laboratory indices were collected at constant time intervals up to one week of admission. A comparison between the laboratory values in both groups was performed. RESULTS: Between May 2008 to November 2011, 41 consecutive patients with a mean age of 54.3 ± 16.7 years were included in this study. No significant correlation was found between routine laboratory indices and the neurological outcome. The temporal trend of decay in the serum glucose values and the ratio of polymorphonuclears to white blood cells during the first 72 hours after admission was steeper in the favorable outcome group (P for trend < 0.05). CONCLUSIONS: No single routine laboratory index was associated with neurological outcome of survivors of cardiac arrest treated with hypothermia. The temporal trends in both serum glucose and polymorphonuclear ratio signal a more intense inflammatory response associated with poor outcome.

[ONE YEAR FOLLOW-UP OF PATIENTS AFTER CARDIAC ARREST TREATED WITH THERAPEUTIC HYPOTHERMIA: PROSPECTIVE COHORT STUDY COMPARED WITH HISTORICAL CONTROL].

BACKGROUND: Mild therapeutic hypothermia has been shown to reduce mortality and neurological morbidity in post cardiac arrest survivors. These beneficial effects had initially been reported in retrospective studies and subsequently more evidence has been gathered by two cornerstone randomized control trials. All these studies focused on the acute outcome and the clinical status at the time of hospital discharge. The main goal of this study was to describe the long term effects of therapeutic hypothermia in this population. PATIENTS AND METHODS: A prospective cohort with a historical control group was used in this study. All consecutive patients eligible for therapeutic hypothermia after cardiac arrest were enrolled. These patients were compared to an historical control group of patients who had met the same criteria of treatment with therapeutic hypothermia, but were not treated since it was not yet available. Patients' records and clinical assessment at 1 week, one, six and twelve months follow-up were collected. RESULTS: In the present study 54 consecutive patients were recruited prospectively, treated with mild hypothermia and 41 patients served as the historical control group for a similar period of time. The cooling group was significantly younger than the control group, 54 ± 16.3 versus 61.1 ± 14.5 years (p < 0.04). Peripheral arterial embolism complication was more common in the hypothermia group. 11.1% versus 0% (p < 0.035). No other clinically meaningful differences were found. In this respect, the beneficial trend towards reduced neurological outcome and mortality was observed in favor of the cooling group, which was statistically significant at six months follow-up (p < 0.044). Beyond 6 months the differences did not reach statistical significance. CONCLUSION: In the current phase of the study, a tendency in favor of mild cooling was observed in the short and medium term outcomes in patients resuscitated after out of hospital cardiac arrest due to fatal arrhythmia. The current results indicate that in spite of high survival rates after the acute stage in the cooling group, the long term mortality rate in this group is still high.

Adjunctive mild hypothermia therapy to primary percutaneous coronary intervention in patients with ST segment elevation myocardial infarction complicated with cardiogenic shock: A pilot feasibility study.

BACKGROUND: Despite successful primary reperfusion therapy, patients may develop large myocardial infarction related in part to reperfusion injury. Induction of mild therapeutic hypothermia (TH) applied in patients has demonstrated beneficial effect in reducing reperfusion injury. The aim of the study was to evaluate the feasibility and safety of adjunctive mild TH to primary percutaneous coronary intervention (PPCI) in patients with acute ST elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS). METHODS: We conducted a prospective single center, open label, historical control study. Patients presenting with STEMI and CS despite maximal support therapy scheduled for PPCI were included. Death was defined as primary endpoint. Secondary outcomes included: TH adverse effect--such as fever, refractory hypotension and arrhythmias, infarct size measured by area under the curve of biomarkers. RESULTS: Eight consecutive patients were prospectively enrolled (TH group). Thirteen clinically similar patients identified from our database, admitted over 2 years, comprised the historical control group (control group). In the hypothermia group, the mortality was 50% compared with 46% in the control group. There was no difference in the secondary outcomes. CONCLUSIONS: TH as adjunctive therapy in STEMI patients complicated with CS is feasible and safe. Based on these preliminary observations there appears to be no significant clinical advantage to this form of therapy.