THERAPEUTIC HYPOTHERMIA课件.pptVIP

THERAPEUTIC HYPOTHERMIA Heike Geduld August 2007 精品文档 What is it? First described in 1950s but no formal testing Revival of interest following animal studies Moderate hypothermia - core temperature 32-34oC 精品文档 When is it used? Out-of hospital cardiac arrest In-hospital cardiac arrest Head Injury/ Ischaemic stroke Perinatal asphyxia Cardiac surgery Neurosurgery Vascular surgery 精品文档 What is the evidence? From animal models - moderate hypothermia cerebral metabolic O2 rate suppress chemical reactions associated with reperfusion injury 精品文档 Out-of Hospital VF arrest with ROSC 2 randomised controlled trials European - within 4hrs, for 24hrs 55% vs 39% favourable neurological outcome Mortality 41% vs 55% (included 10pts with IHA) 精品文档 Australian study pseudorandomised, maintain temp for 12hrs 51%vs 26% favourable neurological outcome 51 vs 68% mortality 精品文档 Problems Highly specific population - excluded persistently hypotensive pts (SBP90) Only pts whose cause of arrest was cardiac- VF arrest primarily Mostly out-of-hospital 精品文档 Complications Low cardiac index arrythmias Pneumonia Sepsis Bleeding Local cold injury Rebound hyperthermia 精品文档 In Head Injury? Cochrane review 2004 - no evidence for benefit 精品文档 Therapeutic hypothermia following perinatal asphyxia. Arch.Dis Child Fetal Neonatal Ed. Mar 2006;91.F127-31 Edwards AD, Azzopardi DV. Division of Clinical Sciences, Faculty of Medicine, Imperial College London, UK. David.Edwards@imperial.ac.uk Well constructed and carefully analysed trials of hypothermic neural rescue therapy for infants with neonatal encephalopathy have recently been reported. The data suggest that either selective head cooling or total body cooling reduces the combined chance of death or disability after birth asphyxia. However, as there are still unanswered questions about these treatments, many may still feel that further data are needed before health care policy can be changed to make cooling the standard of