Document Detail

Unexpected fatal neurological deterioration after successful cardio-pulmonary resuscitation and therapeutic hypothermia.
MedLine Citation:
PMID:  17697736     Owner:  NLM     Status:  MEDLINE    
A 77-year-old woman was admitted to the intensive care unit after successful cardiopulmonary resuscitation for out-of-hospital cardiac arrest due to pulseless electrical activity. She was treated with mild therapeutic hypothermia to minimise secondary anoxic brain damage. After a 24 h period of therapeutic hypothermia with a temperature of 32.5 degrees C, the patient was rewarmed and sedation discontinued. Neurological evaluation after 24 h revealed a maximum Glasgow Coma Score of E4M4Vt with spontaneous breathing. However the patient developed a fever reaching 39 degrees C for several hours that was unresponsive to conventional cooling methods. In the subsequent 24 h patient developed apnoea, hypotension and bradycardia with deterioration of the coma score. Diabetes insipidus was confirmed. Cerebral CT was performed which showed diffuse brain oedema with herniation and brainstem compression. The patient died within hours. Autopsy showed massive brain swelling and tentorial herniation. Hyperthermia possibly played a pivotal role in the development of this fatal insult to this vulnerable brain after cardiac arrest and therapeutic hypothermia treatment. The acute histopathological alterations in the brain, possibly caused by the deleterious effects of fever after cardiac arrest in human brain, may be considered a new observation.
R Bergman; D H T Tjan; M W Adriaanse; R van Vugt; A R H van Zanten
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-08-13
Journal Detail:
Title:  Resuscitation     Volume:  76     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-17     Completed Date:  2008-04-10     Revised Date:  2009-08-25    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  142-5     Citation Subset:  IM    
Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands.
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MeSH Terms
Brain Edema / etiology*
Cardiopulmonary Resuscitation* / adverse effects
Fatal Outcome
Glasgow Coma Scale
Heart Arrest / therapy*
Hypothermia, Induced* / adverse effects
Hypoxia, Brain / etiology*

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