Therapeutic Hypothermia for Brain Injury after Cardiac Arrest

Fred Rincon; Stephan A. Mayer

doi:10.1055/s-2006-948319

Seminars in Neurology, Table of Contents

Semin Neurol 2006; 26(4): 387-395
DOI: 10.1055/s-2006-948319

Therapeutic Hypothermia for Brain Injury after Cardiac Arrest

Fred Rincon¹ , Stephan A. Mayer¹ ^, ²

¹Neurological Intensive Care Unit, Division of Stroke and Critical Care, Department of Neurology, Columbia University, New York, New York
²Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York

Abstract

ABSTRACT

Morbidity and mortality in patients successfully resuscitated from cardiac arrest primarily depends on neurological outcome. Clinical trials of therapies directed toward reducing the extent of neuronal damage by means of pharmacological agents have been disappointing. To date, the only clinically effective tool for amelioration of brain damage by ischemia and reperfusion is mild to moderate induced hypothermia. The pathophysiology of global hypoxic-ischemic brain injury, the mechanisms by which hypothermia confers neuroprotection, and the encouraging beneficial effects of mild to moderate hypothermia in experimental studies and clinical trials are discussed.

KEYWORDS

Ventricular fibrillation - asystole - reperfusion injury

Full Text

References

REFERENCES

1 Krause G S, Kumar K, White B C, Aust S D, Wiegenstein J G. Ischemia, resuscitation, and reperfusion: mechanisms of tissue injury and prospects for protection. Am Heart J. 1986; 111 768-780
2 Cummins R O, Ornato J P, Thies W H, Pepe P E. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation. 1991; 83 1832-1847
3 Cummins R O, Eisenberg M S, Litwin P E et al.. Automatic external defibrillators used by emergency medical technicians: a controlled clinical trial. JAMA. 1987; 257 1605-1610
4 Earnest M P, Yarnell P R, Merrill S L, Knapp G L. Long-term survival and neurologic status after resuscitation from out-of-hospital cardiac arrest. Neurology. 1980; 30 1298-1302
5 Eisenberg M S, Copass M K, Hallstrom A P et al.. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med. 1980; 302 1379-1383
6 Bedell S E, Delbanco T L, Cook E F, Epstein F H. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983; 309 569-576
7 Brain Resuscitation Clinical Trial I Study Group . Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. N Engl J Med. 1986; 314 397-403
8 Brain Resuscitation Clinical Trial II Study Group . A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med. 1991; 324 1225-1231
9 Jastremski M, Sutton-Tyrrell K, Vaagenes P et al.. Glucocorticoid treatment does not improve neurological recovery following cardiac arrest. Brain Resuscitation Clinical Trial I Study Group. JAMA. 1989; 262 3427-3430
10 Erecinska M, Silver I A. ATP and brain function. J Cereb Blood Flow Metab. 1989; 9 2-19
11 Eleff S M, Maruki Y, Monsein L H et al.. Sodium, ATP, and intracellular pH transients during reversible complete ischemia of dog cerebrum. Stroke. 1991; 22 233-241
12 Nishijima M K, Koehler R C, Hurn P D et al.. Postischemic recovery rate of cerebral ATP, phosphocreatine, pH, and evoked potentials. Am J Physiol. 1989; 257 H1860-H1870
13 Hossmann K A, Grosse Ophoff B. Recovery of monkey brain after prolonged ischemia: I. Electrophysiology and brain electrolytes. J Cereb Blood Flow Metab. 1986; 6 15-21
14 Hansen A J. Effect of anoxia on ion distribution in the brain. Physiol Rev. 1985; 65 101-148
15 Silver I A, Erecinska M. Intracellular and extracellular changes of [Ca2 + ] in hypoxia and ischemia in rat brain in vivo. J Gen Physiol. 1990; 95 837-866
16 Hansen A J, Gjedde A, Siemkowicz E. Extracellular potassium and blood flow in the post-ischemic rat brain. Pflugers Arch. 1980; 389 1-7
17 Hansen A J, Zeuthen T. Extracellular ion concentrations during spreading depression and ischemia in the rat brain cortex. Acta Physiol Scand. 1981; 113 437-445
18 Katsura K, Rodriguez de Turco E B, Folbergrova J, Bazan N G, Siesjo B K. Coupling among energy failure, loss of ion homeostasis, and phospholipase A2 and C activation during ischemia. J Neurochem. 1993; 61 1677-1684
19 Sutton L N, Clark B J, Norwood C R, Woodford E J, Welsh F A. Global cerebral ischemia in piglets under conditions of mild and deep hypothermia. Stroke. 1991; 22 1567-1573
20 Siesjo B K, Ljunggren B. Cerebral energy reserves after prolonged hypoxia and ischemia. Arch Neurol. 1973; 29 400-407
21 Berger C, Schabitz W R, Georgiadis D et al.. Effects of hypothermia on excitatory amino acids and metabolism in stroke patients: a microdialysis study. Stroke. 2002; 33 519-524
22 Drews G, Debuyser A, Nenquin M, Henquin J C. Galanin and epinephrine act on distinct receptors to inhibit insulin release by the same mechanisms including an increase in K + permeability of the B-cell membrane. Endocrinology. 1990; 126 1646-1653
23 Yu K T, Pessin J E, Czech M P. Regulation of insulin receptor kinase by multisite phosphorylation. Biochimie. 1985; 67 1081-1093
24 Prakash O, Jonson B, Bos E et al.. Cardiorespiratory and metabolic effects of profound hypothermia. Crit Care Med. 1978; 6 340-346
25 Wong K C. Physiology and pharmacology of hypothermia. West J Med. 1983; 138 227-232
26 Oku K, Sterz F, Safar P et al.. Mild hypothermia after cardiac arrest in dogs does not affect postarrest multifocal cerebral hypoperfusion. Stroke. 1993; 24 1590-1597 discussion 8
27 Danzl D F, Pozos R S. Accidental hypothermia. N Engl J Med. 1994; 331 1756-1760
28 Mair P, Kornberger E, Schwarz B, Baubin M, Hoermann C. Forward blood flow during cardiopulmonary resuscitation in patients with severe accidental hypothermia: an echocardiographic study. Acta Anaesthesiol Scand. 1998; 42 1139-1144
29 Bernard S A, Jones B M, Horne M K. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med. 1997; 30 146-153
30 Yanagawa Y, Ishihara S, Norio H et al.. Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest. Resuscitation. 1998; 39 61-66
31 Hypothermia after Cardiac Arrest Study Group . Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346 549-556
32 Bernard S A, Gray T W, Buist M D et al.. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346 557-563
33 Hachimi-Idrissi S, Corne L, Ebinger G, Michotte Y, Huyghens L. Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation. 2001; 51 275-281
34 Eisenburger P, Sterz F, Holzer M et al.. Therapeutic hypothermia after cardiac arrest. Curr Opin Crit Care. 2001; 7 184-188
35 Felberg R A, Krieger D W, Chuang R et al.. Hypothermia after cardiac arrest: feasibility and safety of an external cooling protocol. Circulation. 2001; 104 1799-1804
36 Mayer S, Commichau C, Scarmeas N et al.. Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients. Neurology. 2001; 56 292-298
37 Dae M W, Gao D W, Ursell P C, Stillson C A, Sessler D I. Safety and efficacy of endovascular cooling and rewarming for induction and reversal of hypothermia in human-sized pigs. Stroke. 2003; 34 734-738
38 Harris B A, Andrews P JD. Direct brain cooling. In: Mayer SA, Sessler DI Therapeutic Hypothermia. New York; Marcel Dekker 2005: 323-386
39 Rajek A, Greif R, Sessler D I et al.. Core cooling by central venous infusion of ice-cold (4 degrees C and 20 degrees C) fluid: isolation of core and peripheral thermal compartments. Anesthesiology. 2000; 93 629-637
40 Bernard S A, Buist M D, Monteiro O, Smith K. Induced hypothermia using large volume, ice-cold intravenous fluids in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation. 2003; 56 9-13
41 Kim F, Olsufka M, Carlbom D et al.. Pilot study of rapid infusion of 2 L of 4 degrees C normal saline for induction of mild hypothermia in hospitalized, comatose survivors of out-of-hospital cardiac arrest. Circulation. 2005; 112 715-719
42 Polderman K H, Rijnsburger E R, Peerdeman S M, Girbes A R. Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med. 2005; 33 2744-2751
43 Safar P, Kochanek P. Cerebral blood flow promotion after prolonged cardiac arrest. Crit Care Med. 2000; 28 3104-3106
44 Safar P, Xiao F, Radovsky A et al.. Improved cerebral resuscitation from cardiac arrest in dogs with mild hypothermia plus blood flow promotion. Stroke. 1996; 27 105-113
45 Bernard S, Buist M, Monteiro O, Smith K. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation. 2003; 56 9-13
46 Steiner T, Meisel F, Mayer S A. Complications of rewarming. In: Mayer SA, Sessler DI Therapeutic Hypothermia. New York; Marcel Dekker 2005: 211-228
47 Enomoto S, Hindman B J, Dexter F, Smith T, Cutkomp J. Rapid rewarming causes an increase in the cerebral metabolic rate for oxygen that is temporarily unmatched by cerebral blood flow: a study during cardiopulmonary bypass in rabbits. Anesthesiology. 1996; 84 1392-1400
48 Akca O. Complications of hypothermia. In: Mayer SA, Sessler DI Therapeutic Hypothermia. New York; Marcel Dekker 2005: 179-210
49 Clifton G L, Miller E R, Choi S C et al.. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med. 2001; 344 556-563
50 Marion D W, Penrod L E, Kelsey S F et al.. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med. 1997; 336 540-546
51 Kuboyama K, Safar P, Radovsky A et al.. Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study. Crit Care Med. 1993; 21 1348-1358
52 Bernard S. New indications for the use of therapeutic hypothermia. Crit Care. 2004; 8 E1

Stephan A MayerM.D.

Neurological Institute

710 West 168th Street, Box 39, New York, NY 10032