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The beneficial effect of mild therapeutic hypothermia depends on the time of complete circulatory standstill in patients with cardiac arrest.
MedLine Citation:
PMID:  22138057     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: Mild therapeutic hypothermia has shown to improve long-time survival as well as favourable functional outcome after cardiac arrest. Animal models suggest that ischemic durations beyond eight minutes results in progressively worse neurologic deficits. Based on these considerations, it would be obvious that cardiac arrest survivors would benefit most from mild therapeutic hypothermia if they have reached a complete circulatory standstill of more than eight minutes. METHODS: In this retrospective cohort study we included cardiac arrest survivors of 18 years of age or older suffering a witnessed out-of-hospital cardiac arrest, which remain comatose after restoration of spontaneous circulation. Data were collected from 1992 to 2010. We investigated the interaction of 'no-flow' time on the association between post arrest mild therapeutic hypothermia and good neurological outcome. 'No-flow' time was categorized into time quartiles (0, 1-2, 3-8, >8minutes). RESULTS: One thousand-two-hundred patients were analysed. Hypothermia was induced in 598 patients. In spite of showing a statistically significant improvement in favourable neurologic outcome in all patients treated with mild therapeutic hypothermia (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.14-1.93) this effect varies with 'no-flow' time. The effect is significant in patients with 'no-flow' times of more than two minutes (OR: 2.72; CI: 1.35-5.48) with the maximum benefit in those with 'no-flow' times beyond eight minutes (OR: 6.15; CI: 2.23-16.99). CONCLUSION: The beneficial effect of mild therapeutic hypothermia increases with cumulative time of complete circulatory standstill in patients with witnessed out-of-hospital cardiac arrest.
Authors:
Christoph Testori; Fritz Sterz; Michael Holzer; Heidrun Losert; Jasmin Arrich; Harald Herkner; Danica Krizanac; Christian Wallmüller; Peter Stratil; Andreas Schober; David Hörburger; Mathias Stöckl; Christoph Weiser; Thomas Uray
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-29
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Ireland Ltd.
Affiliation:
Department of Emergency Medicine, Medical University of Vienna, Austria.
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