Background: Brain perfusion is a key factor in neuron protection after an acute event. Numerous strategies aim at maintaining an adequate perfusion pressure by leveraging on systemic blood pressure. Hypothermia has been demonstrated to deeply affect brain perfusion and intracranial pressure. The aim of this retrospective observational study is to assess the key factors of therapeutic hypothermia that improve the survival of comatose patients after cardiac arrest. Methods: We enrolled all the comatose patients treated with therapeutic hypothermia after cardiac arrest admitted to the Neuro-Intensive-Care-Unit of the NOCSAE hospital (Modena, Italy) in the years 2013 and 2014. Demographic and clinical variables were recorded, temperature curves were obtained for the duration of the treatment. The 30-day mortality was observed. Results: A total of 39 consecutive patients were enrolled in the study. There was a 56.4% mortality at 30 days. Having achieved a state of hypothermia (body temperature <36°C) within the first 6 hours from admission improved survival (hazard ratio 0.37±0.15 da 0.17 a 0.83 p-value 0.016) and neurological outcome measured as Glasgow Coma Scale improvement at discharge from the Intensive Care Unit (p-value 0.0001). Discussion: Hypothermia is a neuro-protective therapy that deeply affects tissue perfusion. An early application of hypothermia can significantly improve not only survival but also neurological outcome after cardiac arrest.
Background: la perfusione cerebrale è un fattore chiave della protezione dei neuroni dopo un danno acuto. Numerose strategie mirano a mantenere un'adeguata pressione di perfusione, agendo sulla pressione arteriosa sistemica. L'ipotermia può influenzare profondamente perfusione cerebrale e la pressione intracranica. Lo scopo di questo studio osservazionale retrospettivo è quello di valutare i fattori chiave dell'ipotermia terapeutica nel miglioramento della sopravvivenza dei pazienti in coma dopo un arresto cardiaco. Materiali e Metodi: Sono stati arruolati tutti i pazienti in coma trattati con ipotermia terapeutica dopo arresto cardiaco ricoverati presso la Neurorianimazione dell'ospedale NOCSAE (Modena, Italia) negli anni 2013 e 2014. Le variabili demografiche e cliniche sono state analizzate, le curve di temperatura sono stati registrate per la durata del trattamento. La mortalità è a 30 giorni è stata considerata. Risultati: Un totale di 39 pazienti consecutivi sono stati arruolati nello studio. La mortalità è stata del 56,4% a 30 giorni. L'aver raggiunto uno stato di ipotermia (temperatura corporea <36 ° C) entro le prime 6 ore dal ricovero è associato ad un miglioramento della sopravvivenza (hazard ratio 0,37 ± 0,15 da 0,17 a 0.83 p-value 0,016) e l'outcome neurologico misurata come Glasgow Coma Scale alla dimissione dalla Neurorianimazione (p-value 0,0001). Discussione: L'ipotermia è una terapia neuro-protettiva che influenza profondamente la perfusione tissutale. Un’applicazione precoce dell’ipotermia può migliorare in modo significativo non solo la sopravvivenza, ma anche l’outcome neurologico dopo l'arresto cardiaco.
Dai biomarcatori di danno cerebrale alla neuroprotezione
GIULIANI, Enrico
2016
Abstract
Background: Brain perfusion is a key factor in neuron protection after an acute event. Numerous strategies aim at maintaining an adequate perfusion pressure by leveraging on systemic blood pressure. Hypothermia has been demonstrated to deeply affect brain perfusion and intracranial pressure. The aim of this retrospective observational study is to assess the key factors of therapeutic hypothermia that improve the survival of comatose patients after cardiac arrest. Methods: We enrolled all the comatose patients treated with therapeutic hypothermia after cardiac arrest admitted to the Neuro-Intensive-Care-Unit of the NOCSAE hospital (Modena, Italy) in the years 2013 and 2014. Demographic and clinical variables were recorded, temperature curves were obtained for the duration of the treatment. The 30-day mortality was observed. Results: A total of 39 consecutive patients were enrolled in the study. There was a 56.4% mortality at 30 days. Having achieved a state of hypothermia (body temperature <36°C) within the first 6 hours from admission improved survival (hazard ratio 0.37±0.15 da 0.17 a 0.83 p-value 0.016) and neurological outcome measured as Glasgow Coma Scale improvement at discharge from the Intensive Care Unit (p-value 0.0001). Discussion: Hypothermia is a neuro-protective therapy that deeply affects tissue perfusion. An early application of hypothermia can significantly improve not only survival but also neurological outcome after cardiac arrest.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14242/214862
URN:NBN:IT:UNIMORE-214862