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 Printable version |
Hypothermia in the management of cardiac arrest |
Sang Thrombose Vaisseaux. Volume 17, Number 7, 371-6, Septembre 2005, Mini-revue
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 Résumé
Article gratuit
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Author(s) : Lionel Lamhaut, Virginie Lemiale, Alain Cariou |
Summary : In spite of significant medical advances in terms of pre-hospital care, sudden cardiac arrest (CA) remains a major challenge for public health with a high frequency of neurologic sequelae and an important mortality rate. Pre-hospital resuscitation success does not systematically correspond to a good prognosis. In the category of patients admitted alive to the ICU, hospital outcome is still uncertain because of two categories of problems. Chronologically the most frequently encountered problem is related to acute circulatory failure that follows reperfusion and that may occasionally lead to organ dysfunctions and death (this phenomenon is usually called “post resuscitation syndrome”). The second problem is brain anoxic damages. To date, only mild hypothermia (32-34°C) has been proved to reduce the neurologic consequences of CA and to improve the in-hospital mortality. Although the precise cellular mechanisms that explain these protective effects are not well elucidated and are probably multiple, mild hypothermia is now recommended in international guidelines. Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled between 32°C and 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation. Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest. Therapeutic hypothermia must be employed with a rigorous method since it can also produce adverse effects. |
Keywords : cardiac arrest, post resuscitation syndrome, brain anoxic damage, mild hypothermia |
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