Research

Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system

Nicolas Pichon¹ , Jean Bernard Amiel¹ , Bruno François¹ , Anthony Dugard¹ , Caroline Etchecopar² and Philippe Vignon¹

¹Intensive Care Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France

²Department of Cardiology, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France

author email corresponding author email

Critical Care 2007, 11:R71doi:10.1186/cc5956

Published:	28 June 2007

See related commentary by Böttiger et al., http://ccforum.com/content/11/4/162 and related letter by Patel et al., http://ccforum.com/content/11/4/420

Abstract

Introduction

We evaluated the efficacy of and tolerance to mild therapeutic hypothermia achieved using an endovascular cooling system, and its ability to reach and maintain a target temperature of 33°C after cardiac arrest.

Methods

This study was conducted in the medical-surgical intensive care unit of an urban university hospital. Forty patients admitted to the intensive care unit following out-of-hospital cardiac arrest underwent mild induced hypothermia (MIH). Core temperature was monitored continuously for five days using a Foley catheter equipped with a temperature sensor. Any equipment malfunction was noted and all adverse events attributable to MIH were recorded. Neurological status was evaluated daily using the Pittsburgh Cerebral Performance Category (CPC). We also recorded the mechanism of cardiac arrest, the Simplified Acute Physiologic Score II on admission, standard biological variables, and the estimated time of anoxia. Nosocomial infections during and after MIH until day 28 were recorded.

Results

Six patients (15%) died during hypothermia. Among the 34 patients who completed the period of MIH, hypothermia was steadily maintained in 31 patients (91%). Post-rewarming 'rebound hyperthermia', defined as a temperature of 38.5°C or greater, was observed in 25 patients (74%) during the first 24 hours after cessation of MIH. Infectious complications were observed in 18 patients (45%), but no patient developed severe sepsis or septic shock. The biological changes that occurred during MIH manifested principally as hypokalaemia (< 3.5 mmol/l; in 75% of patients).

Conclusion

The intravascular cooling system is effective, safe and allows a target temperature to be reached fairly rapidly and steadily over a period of 36 hours.