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Cooling
Patients after CPR can reduce Brain Damage,
boost recovery
Newswise — Cooling a person’s body within
six hours of cardiac arrest with successful
CPR might improve survival and lessen brain
damage, according to a new Cochrane review.
The cooling technique, known as therapeutic
hypothermia, “is one of the most successful
treatment options for patients after cardiac
arrest,” said lead author Jasmin Arrich,
M.D., a researcher at the Medical University
of Vienna in Austria.
“Clinical studies showed that by cooling the
body after cardiac arrest to 33 degrees
Celsius (91 degrees Fahrenheit) for 24
hours, patients are 40 percent to 80 percent
more likely to leave the hospital without a
major handicap.”
Arrich and her colleagues pooled data from
three studies of 481 patients who had
suffered cardiac arrest, undergone CPR and
had their hearts restarted.
Those who received hypothermia treatments
were 55 percent more likely than those
receiving standard care to reach a high
brain function test score during their
hospital stay.
They were also 35 percent more likely to
survive to hospital discharge. The
researchers found no evidence of increased
side effects in those who had the therapy.
Arrich described therapeutic hypothermia as
a simple method to improve outcome after
cardiac arrest by using ice packs, cooling
pads or water immersion, as well as by
cooling the body directly using cold IV
fluids or catheters that lower the blood’s
temperature directly.
It’s like putting the brain into hibernation
while the body clears toxins that built up
in the body during the cardiac arrest.
“If patients suffer from sudden cardiac
death, the best way to save their life and
to prevent brain damage is to start with
basic life support immediately and call
professional help,” Arrich said.
“After successful resuscitation, treatment
with mild hypothermia may further help to
improve outcome.
"Of
course, in this situation, patients are
usually unable to decide about their
treatment; therefore it is usually a
physician's task.”
The new review appears in the latest issue
of The Cochrane Library, a publication of
The Cochrane Collaboration, an international
organization that evaluates medical
research.
Systematic reviews like this one draw
evidence-based conclusions about medical
practice after considering both the content
and quality of existing medical trials on a
topic.
Clifton Callaway, M.D., an associate
professor of emergency medicine at the
University of Pittsburgh School of Medicine,
said that the review results confirm the
usefulness of what many physicians already
felt was best practice.
“Mild hypothermia for those successfully
revived from cardiac arrest improves
survival,” he said.
“Perhaps more important, it also decreases
brain injury, so that the person can go back
home fully intact mentally and physically.”
Many patients and their families are
concerned about treatments that might
increase survival following a heart attack
but that can result in severe brain injury.
“For a couple decades we have made strides
in saving the heart so that most people ask
doctors about things like clot dissolving
medications or bypass surgery,” Callaway
said.
“Now there is treatment for the brain as
well and family members should be expecting
it and demanding it be made available.”
David Beiser, M.D., an assistant professor
of medicine at the Emergency Resuscitation
Center of the University of Chicago, said
the review reinforces the standards of care
the American Heart Association set out in
2005.
However not all hospitals will have the
ability to cool patients rapidly who have
been successfully resuscitated.
He likens this to the trauma system where
not every community has the resources needed
to operate a Level 1 Center.
“If a loved one is not at a hospital that
has a cooling protocol in place, family
should ask about the feasibility of a quick
transfer to a center that is familiar with
therapeutic hypothermia,” he said. “At this
point, this is what I would recommend — and
have recommended — to a friend or loved
one.”
The review discloses that Arrich received
funds through a non-restricted grant to the
University from Alsius Corporation, a
company that produces hypothermia supplies.
A co-author received travel grants or
honoraria from Alsius, Kinetic Concepts,
Inc. and Medivance.
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