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Intracerebral monitoring in comatose patients treated withhypothermia after cardiac arrest
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
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2009 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 3, 289-298 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Induced mild hypothermia (32-34 degrees C) has proven to reduce ischemic brain injury and improve outcome after a cardiac arrest (CA). The aim of this investigation was to study the occurrence of increased intracranial pressure (ICP) and neurochemical metabolic changes indicating cerebral ischemia, after CA and cardiopulmonary resuscitation (CPR), when induced hypothermia was applied. METHODS: ICP, brain chemistry and brain temperature were monitored during induced hypothermia and re-warming in four adult unconscious patients with restoration of spontaneous circulation after CA and CPR. RESULTS: ICP was occasionally above 20 mmHg. Neurochemical changes indicating cerebral ischemia (increased lactate/pyruvate ratio) and excitoxicity (increased glutamate) were found after CA, and signs of ischemia were also observed during the re-warming phase. A biphasic increase in glycerol was seen, which may have been a result of both membrane degradation and overspill from the general circulation. CONCLUSIONS: Intracerebral microdialysis and ICP monitoring may be used in selected patients not requiring anticoagulants and PCI to obtain information regarding the common disturbances of intracranial dynamics after CA. The results of this study underline the importance of inducing hypothermia quickly after CA and emphasize the need for developing tools for guidance of the re-warming.

Place, publisher, year, edition, pages
2009. Vol. 53, no 3, 289-298 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-98093DOI: 10.1111/j.1399-6576.2008.01885.xISI: 000263351600003PubMedID: 19243314OAI: oai:DiVA.org:uu-98093DiVA: diva2:173273
Available from: 2009-02-12 Created: 2009-02-12 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Aspects of Induced Hypothermia following Cardiopulmonary Resuscitation: Cerebral and Cardiovascular Effects
Open this publication in new window or tab >>Aspects of Induced Hypothermia following Cardiopulmonary Resuscitation: Cerebral and Cardiovascular Effects
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Hypothermia treatment with cooling to a body temperature of 32-34°C has been shown to be an effective way of improving neurological outcome and survival in unconscious patients successfully resuscitated after cardiac arrest (CA). The method is used clinically but there are still many questions on the biological mechanisms and on how the treatment is best performed. This thesis focuses on cerebral and haemodynamic effects of hypothermia and rewarming.

A porcine model of CA was used. To shorten time to reach target temperature, induction of hypothermia, by means of infusion of 4°C cold fluid, was started already during ongoing cardiopulmonary resuscitation. The temperature was satisfactorily reduced without obvious haemodynamic disturbances.

Cerebral effects of hypothermia and rewarming were studied. Microdialysis monitoring showed signs of cerebral energy failure (increased lactate/pyruvate-ratio) and excitotoxicity (increased glutamate) immediately after CA. There was a risk of secondary energy failure that was reduced by hypothermia. Intracranial pressure (ICP) increased gradually after CA irrespectively of if hypothermia was used or not. There were no indications of increasing cerebral disturbances during rewarming.

Haemodynamic effects of hypothermia treatment and rewarming were examined in a study of patients successfully resuscitated after CA. Hypothermia was induced by means of cold intravenous infusion. No negative effects on the cardiovascular system were revealed. There were indications of decreased intravascular volume in spite of a positive fluid balance.

Cerebral microdialysis and ICP recording were performed in four patients. All patients had signs of energy failure and excitotoxicity following CA. ICP was only exceptionally above 20 mmHg. In contrast to the experimental study indications of increasing ischemia were seen during rewarming. Glycerol had a biphasic pattern, perhaps due to an overspill of metabolites from the general circulation. As most patients become extensively anti-coagulated following CA, intracranial monitoring is not suitable to be used in routine care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 422
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-9562 (URN)978-91-554-7419-5 (ISBN)
Public defence
2009-03-28, Skoogsalen, Akademiska sjukhuset ing. 78/79, Uppsala, 09:15 (English)
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Available from: 2009-02-25 Created: 2009-02-12 Last updated: 2009-02-25Bibliographically approved

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Rubertsson, StenMörtberg, Erik

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