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• W2912126405 abstract "Therapeutic hypothermia (TH) is recommended for patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA). There is still uncertainty about management, target temperature and duration of TH. In the present study we aim to describe the initial experience of a non-tertiary care center with TH after CA and to determine predictors of mortality. During the period 2011-2014, out of 2279 patients hospitalized in the intensive care unit, 82 had a diagnosis of CA with ROSC. We determined predictors of mortality and neurological outcome in comatose patients with ROSC after CA treated by TH. A total of 15 patients were included, mean age 47.3±14 years, 10 (67.0%) male. CA occurred out-of-hospital (n=11; 73.3%) or in-hospital (n=4; 26.7%), in initial shockable (n=10; 66.7%) or non-shockable (n=5, 33.3%) rhythm. The mean time from CA to ROSC (CA-ROSC) was 44.7±36.5 min. All patients met the 24-hour TH target temperature of 33 °C. The mean neuron-specific enolase (NSE) level was 93.7±109.0 μg/l. Seven patients (46.7%) were discharged with good cerebral performance and eight (53.3%) died. Patients who survived had lower median age (p=0.032), shorter CA-ROSC (p=0.048), lower NSE levels (p=0.020) and initial ventricular fibrillation rhythm (p=NS). The effectiveness of TH appears to be related to younger age, shockable initial rhythm and shorter CA-ROSC time. This results indicates some lines of inquiry that should be developed in appropriate prospective studies. The role of biomarkers as predictors of prognosis is an open question, with NSE potentially playing an important role. A Hipotermia Terapêutica (HT) é recomendada em doentes com recuperação da circulação espontânea (ROSC) após paragem cardíaca (PC). Dúvidas persistem sobre a melhor abordagem, a temperatura alvo e a duração da técnica. Neste estudo descrevemos a experiência inicial de um centro não-terciário com HT após PC e procuramos preditores de mortalidade. Durante os anos de 2011-2014, dos 2279 doentes hospitalizados na unidade de cuidados intensivos, 68 tinham diagnóstico de PC com ROSC. Determinámos preditores de mortalidade e prognóstico neurológico nos doentes comatosos com ROSC após PC, submetidos a HT. Quinze doentes, 47,3±14 anos, dez (67,0%) do sexo masculino. A PC ocorreu extra (n=11; 73,3%) ou intra-hospitalar (n=4; 26,7%), em ritmo cardíaco inicial desfibrilhável (n=10; 66,7%) ou não-desfibrilhável (n=5, 33,3%). O tempo médio decorrido desde a PC até à ROSC (PC-ROSC) foi de 44,7±36,5 min. O valor médio da enolase específica dos neurónios (NSE) foi de 93,7±109,0 μg/L. Sete doentes (46,7%) tiveram alta hospitalar com bom desempenho cerebral e oito doentes (53,3%) faleceram. Os doentes que sobreviveram apresentavam idade média inferior (p=0,032), menor tempo PC-ROSC (p=0,048), doseamentos mais baixos de NSE (p=0,020) e ritmo inicial predominante de fibrilhação ventricular (p=NS). A eficácia da HT parece relacionada com idades mais jovens, ritmo inicial desfibrilhável e tempo PC-ROSC reduzido. Estes resultados apontam algumas linhas de investigação que estudos prospetivos adequados deverão desenvolver. O papel de biomarcadores preditores de prognóstico é um tema em aberto, devendo a NSE ocupar um lugar particular neste domínio." @default.
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• W2912126405 date "2016-07-01" @default.
• W2912126405 modified "2023-09-25" @default.
• W2912126405 title "Predictors of death among cardiac arrest patients after therapeutic hypothermia: A non-tertiary care center's initial experience" @default.
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• W2912126405 doi "https://doi.org/10.1016/j.repce.2016.03.005" @default.
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