Mild hypothermia in improving multiple organ dysfunction after cardiac arrest

Abstract

Abstract:

BACKGROUND: Resuscitation after cardiac arrest (CA) with a whole-body ischemia-reperfusion injury causes brain injury and multiple organ dysfunction (MODS). This study aimed to determine whether mild systemic hypothermia could decrease multiple organ dysfunctions after resuscitation from cardiac arrest.

METHODS: The patients who had been resuscitated after cardiac arrest were reviewed. During the resuscitation they had been assigned to undergo therapeutic hypothermia (target temperature, 32°C to 34°C, measured in the rectum) over a period of 24 to 36 hours or to receive standard treatment with normothermia. Markers of different organ injury were evaluated for the first 72 hours after recovery of spontaneous circulation (ROSC).

RESULTS: At 72 hours after ROSC, 23 patients in the hypothermia group for whom data were available had favorable neurologic, myocardial, hepatic and pulmonic outcomes as compared with 26 patients in the normothermia group. The values of renal function were not significantly different between the two groups. However, blood coagulation function was badly injured in the hypothermia group.

CONCLUSION: In the patients who have been successfully resuscitated after cardiac arrest, therapeutic mild hypothermia can alleviate dysfunction after resuscitation from cardiac arrest.

Key words: Cardiac arrest, Ischemia reperfusion injury, Mild hypothermia, Multiple organ dysfunction

Lin Yang, Xu-ming Zhao, Li-jun Liu. Mild hypothermia in improving multiple organ dysfunction after cardiac arrest[J]. World Journal of Emergency Medicine, 2010, 1(3): 196-200.

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Parameters	Hypothermia group (n=23)	Normothermia group (n=26)	P value
Sex (male/female)	15/8	17/9	0.99
Age (years)	59±19	55±18	0.43
SAPS II Sore after ROSC	51±18	57±16	0.25
CA-CPR time (min)	9.3±7.3	8.5±7.9	0.75
CA-ROSC time (min)	37.0±20.7	37.3±23.4	0.96
Cause of CA (number)
Acute myocardial infarction	3	5	0.56
Anoxia	5	5	0.83
Stroke	3	5	0.56
Hypokalemia	5	4	0.57
Organophosphorus pesticide	2	3	0.74
Hemorrhagic shock	5	4	0.57

Groups	0-1 h	1-24 h	24-48 h	48-72 h
Mild hypothermia	5.2±1.5	4.5±1.4	5.6±2.8	6.9±4.5
Normothermia	5.6±1.4	4.7±1.5	4.5±2.4	4.5±3.0

Parameters	0-1 h	1-24 h	24-48 h	48-72 h
Ck-MB (ng/ml)
Mild hypothermia group	30.3±13.3	62.2±10.8^*#	50.4±11.7	49.6±17.1
Normothermia group	28.9±13.2	65.2±13.8	81.8±14.5^*	59.2±13.8
CTnI (ng/ml)
Mild hypothermia group	0.92±0.42	2.74±0.42^*#	1.45±0.40	0.92±0.33
Normothermia group	0.95±0.44	2.80±0.97	2.90±0.83^*	1.64±0.45
PaO₂/FiO₂
Mild hypothermia group	250±50	355±60	398±74	444±79
Normothermia group	240±51	328±57	349±65	369±70

Parameters	0-1 h	1-24 h	24-48 h	48-72 h
STB (μmol/L)
Mild hypothermia group	5.3±1.3	20.9±4.9^*	17.7±4.1	13.3±2.8^#
Normothermia group	5.8±3.1	21.0±5.2^*	20.2±5.2	18.8±5.8
ALT (U/L)
Mild hypothermia group	152±34	167±39^*	130±31	127±31^*#
Normothermia group	142±30	199±42^*	260±64	248±61
Scr (μmol/L)
Mild hypothermia group	113±22	147±31^*	189±37^*	207±39^*
Normothermia group	109±23	147±30^*	184±36^*	197±39^*

Parameters	0-1 h	1-24 h	24-48 h	48-72 h
PLT (*10⁹)
Mild hypothermia group	125.5±34.7	89.5±29.7^*	68.2±22.6^*	52.1±15.6^*#
Normothermia group	117.9±35.4	87.8±33.4^*	78.4±32.9^*	82.5±32.5^*
PT(S)
Mild hypothermia group	16.1±3.9	17.2±4.3	16.4±4.1	16.6±4.1
Normothermia group	15.5±3.6	17.1±3.8	15.9±3.6	16.3±3.5
APTT(S)
Mild hypothermia group	56.3±13.7	59.6±10.3	60.6±12.2	58.8±10.9
Normothermia group	57.8±13.7	62.3±12.4	62.9±13.5	61.3±12.6