Therapeutic Hypothermia After Perioperative Cardiac Arrest in Cardiac Surgical Patients

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background. Therapeutic hypothermia (TH) has been established as an effective treatment for preserving neurological function after out-of-hospital cardiac arrest (CA). Use of TH has been limited in cardiac surgery patients in particular because of concern about adverse effects such as hemorrhage and dysrhythmia. Little published data describe efficacy or safety of TH in cardiac surgical patients who suffer unintentional CA. However, the benefits of TH are such as may suggest clinical equipoise, even in this high-risk patient population. Objective. To report a series of 3 patients in our institution's cardiac surgery ICU who suffered unintentional CA within 48 hours of cardiac surgery and were treated with TH. Methods. After institutional review board approval, study patients were identified by diagnosis of undesired intraoperative CA or arrest on ICU days 1 to 2, as well as having documented TH. The institution's electronic medical record and the Society of Thoracic Surgeons database were retrospectively reviewed for demographic information, comorbid diagnoses, surgical procedure, and outcomes, including hemorrhage, rewarming dysrhythmias, infection, in-hospital mortality, and neurologic outcome were assessed. TH was initiated and monitored using active cooling pads according to written institutional protocol. Results. Four patients received TH after perioperative arrest. One patient was inadequately cooled and had massive surgical bleeding, and was therefore excluded from this review. The remaining 3 patients had a predicted mortality of 14.6% (±13.3) based on Euroscore calculation and were cooled for 17.6 ± 4.0 hours after CA. Coagulopathy, hypovolemia, severe electrolyte abnormalities, and rewarming dysrhythmias were not identified in any patient. Two patients were discharged home and one was discharged to a long-term care facility. Conclusion. Herein we report the safe and successful use of TH after unintentional perioperative CA in 3 cardiac surgery patients. These data suggest that further investigation of this therapy may be warranted given the potential benefit and apparent safety in a small series.

Original languageEnglish (US)
Pages (from-to)271-278
Number of pages8
JournalICU Director
Volume3
Issue number6
DOIs
StatePublished - 2012

Fingerprint

Induced Hypothermia
Heart Arrest
Thoracic Surgery
Rewarming
Hemorrhage
Out-of-Hospital Cardiac Arrest
Safety
Hypovolemia
Electronic Health Records
Research Ethics Committees
Long-Term Care
Hospital Mortality
Nervous System
Electrolytes
Demography

Keywords

  • cardiac arrest
  • cardiac surgery
  • outcome
  • therapeutic hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Management Science and Operations Research
  • Critical Care

Cite this

Therapeutic Hypothermia After Perioperative Cardiac Arrest in Cardiac Surgical Patients. / Rinehart, Thomas W.; Merkel, Matthias; Schulman, Peter; Hutchens, Michael.

In: ICU Director, Vol. 3, No. 6, 2012, p. 271-278.

Research output: Contribution to journalArticle

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abstract = "Background. Therapeutic hypothermia (TH) has been established as an effective treatment for preserving neurological function after out-of-hospital cardiac arrest (CA). Use of TH has been limited in cardiac surgery patients in particular because of concern about adverse effects such as hemorrhage and dysrhythmia. Little published data describe efficacy or safety of TH in cardiac surgical patients who suffer unintentional CA. However, the benefits of TH are such as may suggest clinical equipoise, even in this high-risk patient population. Objective. To report a series of 3 patients in our institution's cardiac surgery ICU who suffered unintentional CA within 48 hours of cardiac surgery and were treated with TH. Methods. After institutional review board approval, study patients were identified by diagnosis of undesired intraoperative CA or arrest on ICU days 1 to 2, as well as having documented TH. The institution's electronic medical record and the Society of Thoracic Surgeons database were retrospectively reviewed for demographic information, comorbid diagnoses, surgical procedure, and outcomes, including hemorrhage, rewarming dysrhythmias, infection, in-hospital mortality, and neurologic outcome were assessed. TH was initiated and monitored using active cooling pads according to written institutional protocol. Results. Four patients received TH after perioperative arrest. One patient was inadequately cooled and had massive surgical bleeding, and was therefore excluded from this review. The remaining 3 patients had a predicted mortality of 14.6{\%} (±13.3) based on Euroscore calculation and were cooled for 17.6 ± 4.0 hours after CA. Coagulopathy, hypovolemia, severe electrolyte abnormalities, and rewarming dysrhythmias were not identified in any patient. Two patients were discharged home and one was discharged to a long-term care facility. Conclusion. Herein we report the safe and successful use of TH after unintentional perioperative CA in 3 cardiac surgery patients. These data suggest that further investigation of this therapy may be warranted given the potential benefit and apparent safety in a small series.",
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