Acute and Critical Care

Review Article

Neurosurgery
Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention: Kwang Wook Jo; Acute Crit Care. 2022;37(4):483-490. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.01291

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Abstract PDF: Traumatic brain injury (TBI) is a critical cause of disability and death worldwide. Many studies have been conducted aimed at achieving favorable neurologic outcomes by reducing secondary brain injury in TBI patients. However, ground-breaking outcomes are still insufficient so far. Because mild-to-moderate hypothermia (32°C–35°C) has been confirmed to help neurological recovery for recovered patients after circulatory arrest, it has been recognized as a major neuroprotective treatment plan for TBI patients. Thereafter, many clinical studies about the effect of therapeutic hypothermia (TH) on severe TBI have been conducted. However, efficacy and safety have not been demonstrated in many large-scale randomized controlled studies. Rather, some studies have demonstrated an increase in mortality rate due to complications such as pneumonia, so it is not highly recommended for severe TBI patients. Recently, some studies have shown results suggesting TH may help reperfusion/ischemic injury prevention after surgery in the case of mass lesions, such as acute subdural hematoma, and it has also been shown to be effective in intracranial pressure control. In conclusion, TH is still at the center of neuroprotective therapeutic studies regarding TBI. If proper measures can be taken to mitigate the many adverse events that may occur during the course of treatment, more positive efficacy can be confirmed. In this review, we look into adverse events that may occur during the process of the induction, maintenance, and rewarming of targeted temperature management and consider ways to prevent and address them.

Original Article

Basic science and research
Therapeutic hypothermia reduces inflammation and oxidative stress in the liver after asphyxial cardiac arrest in rats: Yoonsoo Park, Ji Hyeon Ahn, Tae-Kyeong Lee, Bora Kim, Hyun-Jin Tae, Joon Ha Park, Myoung Cheol Shin, Jun Hwi Cho, Moo-Ho Won; Acute Crit Care. 2020;35(4):286-295. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00304

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Background
Few studies have evaluated the effects of hypothermia on cardiac arrest (CA)-induced liver damage. This study aimed to investigate the effects of hypothermic therapy on the liver in a rat model of asphyxial cardiac arrest (ACA).
Methods
Rats were subjected to 5-minute ACA followed by return of spontaneous circulation (RoSC). Body temperature was controlled at 33°C±0.5°C or 37°C±0.5°C for 4 hours after RoSC in the hypothermia group and normothermia group, respectively. Liver tissues in each group were collected at 6 hours, 12 hours, 1 day, and 2 days after RoSC. To examine hepatic inflammation, mast cells were stained with toluidine blue. Superoxide anion radical production was evaluated using dihydroethidium fluorescence straining and expression of endogenous antioxidants (superoxide dismutase 1 [SOD1] and SOD2) was examined using immunohistochemistry.
Results
There were significantly more mast cells in the livers of the normothermia group with ACA than in the hypothermia group with ACA. Gradual increase in superoxide anion radical production was found with time in the normothermia group with ACA, but production was significantly suppressed in the hypothermia group with ACA relative to the normothermia group with ACA. SOD1 and SOD2 levels were higher in the hypothermia group with ACA than in the normothermia group with ACA.
Conclusions
Experimental hypothermic treatment after ACA significantly inhibited inflammation and superoxide anion radical production in the rat liver, indicating that this treatment enhanced or maintained expression of antioxidants. Our findings suggest that hypothermic therapy after CA can reduce mast cell-mediated inflammation through regulation of oxidative stress and the expression of antioxidants in the liver.

Citations

Citations to this article as recorded by

Prevention and correction of postdecompression liver dysfunction in obstructive jaundice in experimental animals
M. M. Magomedov, M. A. Khamidov, H. M. Magomedov, K. I. Hajiyev
Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH).2021; 11(4): 45. CrossRef
Hypothermic treatment reduces matrix metalloproteinase-9 expression and damage in the liver following asphyxial cardiac arrest in rats
Donghwi Kim, Bora Kim, Hyejin Sim, Tae-Kyeong Lee, Hyun-Jin Tae, Jae-Chul Lee, Joon Ha Park, Jun Hwi Cho, Moo-Ho Won, Yoonsoo Park, Ji Hyeon Ahn
Laboratory Animal Research.2021;[Epub] CrossRef
High Oxygen Does Not Increase Reperfusion Injury Assessed with Lipid Peroxidation Biomarkers after Cardiac Arrest: A Post Hoc Analysis of the COMACARE Trial
Jaana Humaloja, Maximo Vento, Julia Kuligowski, Sture Andersson, José David Piñeiro-Ramos, Ángel Sánchez-Illana, Erik Litonius, Pekka Jakkula, Johanna Hästbacka, Stepani Bendel, Marjaana Tiainen, Matti Reinikainen, Markus B. Skrifvars
Journal of Clinical Medicine.2021; 10(18): 4226. CrossRef

Review Article

CPR/Resuscitation
Management of post-cardiac arrest syndrome: Youngjoon Kang; Acute Crit Care. 2019;34(3):173-178. Published online August 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00654

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20 Citations

Abstract PDF

Post-cardiac arrest syndrome is a complex and critical issue in resuscitated patients undergone cardiac arrest. Ischemic-reperfusion injury occurs in multiple organs due to the return of spontaneous circulation. Bundle of management practicies are required for post-cardiac arrest care. Early invasive coronary angiography should be considered to identify and treat coronary artery obstructive disease. Vasopressors such as norepinephrine and dobutamine are the first-line treatment for shock. Maintainance of oxyhemoglobin saturation greater than 94% but less than 100% is recommended to avoid fatality. Target temperature therapeutic hypothermia helps to resuscitated patients. Strict temperature control is required and is maintained with the help of cooling devices and monitoring the core temperature. Montorings include electrocardiogram, oxymetry, capnography, and electroencephalography (EEG) along with blood pressue, temprature, and vital signs. Seizure should be treated if EEG shows evidence of seizure or epileptiform activity. Clinical neurologic examination and magnetic resonance imaging are considered to predict neurological outcome. Glycemic control and metabolic management are favorable for a good neurological outcome. Recovery from acute kidney injury is essential for survival and a good neurological outcome.

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Dae Ki Hong, A Ra Kho, Song Hee Lee, Beom Seok Kang, Min Kyu Park, Bo Young Choi, Sang Won Suh
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The role of targeted temperature management in 30-day hospital readmissions in cardiac arrest survivors: A national population-based study
Justin Mark, Jose Lopez, Waseem Wahood, Joshua Dodge, Miguel Belaunzaran, Fergie Losiniecki, Yelixa Santos-Roman, Mauricio Danckers
IJC Heart & Vasculature.2023; 46: 101207. CrossRef
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Jan Andreas Kloka, Benjamin Friedrichson, Petra Wülfroth, Rainer Henning, Kai Zacharowski
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Mid-regional pro-adrenomedullin and lactate levels for risk stratification in patients with out-of-hospital cardiac arrest
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Evaluation of Unfractionated Heparin Dosing by Antifactor Xa During Targeted Temperature Management Post Cardiac Arrest
Carrigan Belcher, Vivek Kataria, Klayton M Ryman, Xuan Wang, Joon Yong Moon, Ariel Modrykamien, Adan Mora
Hospital Pharmacy.2022; 57(4): 504. CrossRef
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Exogenous Nicotinamide Adenine Dinucleotide Attenuates Postresuscitation Myocardial and Neurologic Dysfunction in a Rat Model of Cardiac Arrest
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Original Article

CPR/Resuscitation
Comparison between Gel Pad Cooling Device and Water Blanket during Target Temperature Management in Cardiac Arrest Patients: Yoon Sun Jung, Kyung Su Kim, Gil Joon Suh, Jun-Hwi Cho; Acute Crit Care. 2018;33(4):246-251. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00192

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Abstract PDF Supplementary Material

Background
Target temperature management (TTM) improves neurological outcomes for comatose survivors of out-of-hospital cardiac arrest. We compared the efficacy and safety of a gel pad cooling device (GP) and a water blanket (WB) during TTM.
Methods
We performed a retrospective analysis in a single hospital, wherein we measured the time to target temperature (<34°C) after initiation of cooling to evaluate the effectiveness of the cooling method. The temperature farthest from 33°C was selected every hour during maintenance. Generalized estimation equation analysis was used to compare the absolute temperature differences from 33°C during the maintenance period. If the selected temperature was not between 32°C and 34°C, the hour was considered a deviation from the target. We compared the deviation rates during hypothermia maintenance to evaluate the safety of the different methods.
Results
A GP was used for 23 patients among of 53 patients, and a WB was used for the remaining. There was no difference in baseline temperature at the start of cooling between the two patient groups (GP, 35.7°C vs. WB, 35.6°C; P=0.741). The time to target temperature (134.2 minutes vs. 233.4 minutes, P=0.056) was shorter in the GP patient group. Deviation from maintenance temperature (2.0% vs. 23.7%, P<0.001) occurred significantly more frequently in the WB group. The mean absolute temperature difference from 33°C during the maintenance period was 0.19°C (95% confidence interval [CI], 0.17°C to 0.21°C) in the GP group and 0.76°C (95% CI, 0.71°C to 0.80°C) in the WB group. GP significantly decreased this difference by 0.59°C (95% CI, 0.44°C to 0.75°C; P<0.001).
Conclusions
The GP was superior to the WB for strict temperature control during TTM.

Citations

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Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C
Seok Jin Ryu, Dong Hun Lee, Byung Kook Lee, Kyung Woon Jeung, Yong Hun Jung, Jung Soo Park, Jin Hong Min, Dong Ki Kim
Therapeutic Hypothermia and Temperature Management.2022; 12(2): 74. CrossRef
Comparison of hydrogel pad and water-circulating blanket cooling methods for targeted temperature management: A propensity score-matched analysis from a prospective multicentre registry
Kyoung Tak Keum, Yong Hwan Kim, Jun Ho Lee, Seong Jun Ahn, Seong Youn Hwang, Joo Suk Oh, Su Jin Kim, Soo Hyun Kim, Kyung Woon Jeung
Resuscitation.2021; 169: 78. CrossRef
Use of a Servo-Controlled Cooling Gel Pad System to Regulate Body Temperature in Critically Ill Children
Gema Pérez, Gema Manrique, Julia García, Sara de la Mata, Débora Sanz, Jesús López-Herce
Pediatric Critical Care Medicine.2020; 21(12): e1094. CrossRef
Management of post-cardiac arrest syndrome
Youngjoon Kang
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Case Report

Obstetric/Emergency
Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage: Kwang Ho Lee, Seong Jin Choi, Yeong Gwan Jeon, Raing Kyu Kim, Dae Ja Um; Korean J Crit Care Med. 2016;31(4):359-363. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00325

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Abstract PDF

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.

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Persephin as a diagnostic marker of acute brain injury in critically ill newborns: a clinical trial
A. A. Zadvornov, E. V. Grigoriev
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Original Article

Neurology/Infection
Effect of Antibiotic Prophylaxis on Early-Onset Pneumonia in Cardiac Arrest Patients Treated with Therapeutic Hypothermia: Soo Jung Kim, Jung Kyu Lee, Deog Kyeom Kim, Jong Hwan Shin, Ki Jeong Hong, Eun Young Heo; Korean J Crit Care Med. 2016;31(1):17-24. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.17

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4 Citations

Abstract PDF

Background:
Infectious complications frequently occur after cardiac arrest and may be even more frequent after therapeutic hypothermia. Pneumonia is the most common infectious complication associated with therapeutic hypothermia, and it is unclear whether prophylactic antibiotics administered during this intervention can decrease the development of early-onset pneumonia. We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia.
Methods
We retrospectively reviewed the medical records of patients who were admitted for therapeutic hypothermia after resuscitation for out-of-hospital cardiac arrest between January 2010 and July 2015. Patients who died within the first 72 hours or presented with pneumonia at the time of admission were excluded. Early-onset pneumonia was defined as pneumonia that developed within 5 days of admission. Prophylactic antibiotic therapy was defined as the administration of any parenteral antibiotics within the first 24 hours without any evidence of infection.
Results
Of the 128 patients admitted after cardiac arrest, 68 were analyzed and 48 (70.6%) were treated with prophylactic antibiotics within 24 hours. The frequency of early-onset pneumonia was not significantly different between the prophylactic antibiotic group and the control group (29.2% vs 30.0%, respectively, p = 0.945). The most commonly used antibiotic was third-generation cephalosporin, and the class of prophylactic antibiotics did not influence early-onset pneumonia.
Conclusion
Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.

Citations

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Hypothermia as a potential remedy for canine and feline acute spinal cord injury: a review
Igor Šulla, Slavomír Horňák, Vladimír Balik
Acta Veterinaria Brno.2022; 91(2): 189. CrossRef
Prophylactic antibiotic use following cardiac arrest: A systematic review and meta-analysis
Keith Couper, Ryan Laloo, Richard Field, Gavin D. Perkins, Matthew Thomas, Joyce Yeung
Resuscitation.2019; 141: 166. CrossRef
A review of novel trends in management of canine spinal cord injury
Igor Šulla, Slavomír Horňák, Valent Ledecký, Vladimír Balik
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Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef

Case Report

Cardiology
Recurrent Pulseless Ventricular Tachycardia Induced by Commotio Cordis Treated with Therapeutic Hypothermia: Sanghyun Lee, Hyunggoo Kang, Taeho Lim, Jaehoon Oh, Chiwon Ahn, Juncheal Lee, Changsun Kim; Korean J Crit Care Med. 2015;30(4):349-353. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.349

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Abstract PDF: The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33°C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.

Original Articles

Pharmacology
Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect: Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi; Korean J Crit Care Med. 2015;30(4):272-279. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.272

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Abstract PDF: Background
This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33℃ target temperature management.
Methods
A retrospective study was conducted on patients who underwent 33℃ target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia.
Results
A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 ± 0.15 μg/kg/h. Decisions of charged doctor’s were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole.
Conclusions
Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33℃ target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33℃ targeted temperature management.

Emergency/Neurology
Brain Magnetic Resonance Imaging in Patients with Favorable Outcomes after Out-of-Hospital Cardiac Arrest: Many Have Encephalopathy Even with a Good Cerebral Performance Category Score: Woo Sung Choi, Jin Joo Kim, Hyuk Jun Yang; Korean J Crit Care Med. 2015;30(4):265-271. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.265

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Abstract PDF: Background
The aim of this study was to retrospectively evaluate and analyze the brain magnetic resonance imaging (B-MRI) findings of patients with a favorable neurological outcome following cerebral performance category (CPC) after out-of-hospital cardiac arrest (OHCA) at single university hospital emergency center.
Methods
Patients with return of spontaneous circulation (> 24 h) after OHCA who were older than 16 years of age and who had been admitted to the emergency intensive care unit (EICU) for over a 57-month period between July 2007 and March 2012 and survived with a favorable neurological outcome were enrolled. B-MRI was taken after recovery of their mental status.
Results
Fifty-two patients among the 305 admitted patients had a good CPC, and 33 patients’ B-MRI were analyzed (CPC 1: 26 patients, CPC 2: 7 patients). Among these, 18 (54.5%) patients had a normal finding on B-MRI. On the other hand, ischemia/infarction/microangiopathy compatible with hypoxic-ischemic encephalopathy (HIE) were found on various brain areas including subcortical white matter (7/13), cerebral cortex, central semiovlae, basal ganglia, putamen, periventricular white matter, and cerebellum.
Conclusions
Survivors with a favorable neurological outcome from OHCA showed HIE on B-MRI, especially all of the patients with a CPC 2. More detail neurologic category including brain imaging would be needed to categorize patients with favorable outcome after OHCA.

Review

Neurosurgery
Therapeutic Hypothermia in Traumatic Brain injury; Review of History, Pathophysiology and Current Studies: Do-Keun Kim, Dong-Keun Hyun; Korean J Crit Care Med. 2015;30(3):143-150. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.143

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Abstract PDF: The fact that therapeutic hypothermia (TH) has lowered intracranial pressure and protected brain in severe traumatic brain injury (TBI) is well known throughout past sources and experimental data. In this paper, the result of TH in TBI needs to be confirmed. The result of North American Brain Injury Study; Hypothermia (NAVIS-H) 1 and 2, Eurotherm3235, Japan trauma society study was reviewed throughout randomized controlled study which performed recently. The prognosis was not confirmed throughout TH in NAVIS-H1; however, there was statistical significance among the group of 45 years or less and below 35 degree in celcius which checked when he or she visited initially. Hence, NAVIS-H2 study was preceded. In patient who had surgically removed hematoma, the effects of TH were proved compared to diffuse brain damage in NAVIS-H2 study. This was found in the result of Japan neurotrauma data bank. Eurotherm study has been doing, which leads to collect many data later on. The TBI of TH makes them better prognosis in patients who had surgically removed hematoma and lowered initial body temperature. Later on, it is considered further study is necessary.

Original Articles

Neurology/Emergency
Prognostic Value and Optimal Sampling Time of S-100B Protein for Outcome Prediction in Cardiac Arrest Patients Treated with Therapeutic Hypothermia: Hyung Seok Kim, Ho Sung Jung, Yong Su Lim, Jae Hyug Woo, Jae Ho Jang, Jee Yong Jang, Hyuk Jun Yang; Korean J Crit Care Med. 2014;29(4):304-312. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.304

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Abstract PDF

BACKGROUND
The aim of this study was to determine the prognostic value and optimal sampling time of serum S-100B protein for the prediction of poor neurological outcomes in post-cardiac arrest (CA) patients treated with therapeutic hypothermia (TH).
METHODS
We prospectively measured serum S100 calcium binding protein beta subunit (S-100B protein) levels 12 times (0-96 hours) after the return of spontaneous circulation (ROSC). The patients were classified into two groups based on cerebral performance category (CPC): the good neurological outcome group (CPC 1-2 at 6 months) and the poor neurological outcome group (CPC 3-5). We compared serial changes and serum S-100B protein levels at each time point between the two groups and performed receiver operating characteristic curve analysis for the prediction of poor neurological outcomes.
RESULTS
A total of 40 patients were enrolled in the study. S-100B protein levels peaked at ROSC (0 hour), decreased rapidly to 6 hours and maintained a similar level thereafter. Serum S-100B protein levels in the poor CPC group (n = 22) were significantly higher than in the good CPC group (n = 18) at all time points after ROSC except at 4 hours. The time points with highest area under curve were 24 (0.829) and 36 (0.837) hours. The cut-off value, the sensitivity (24/36 hours) and specificity (24/36 hours) for the prediction of poor CPC at 24 and 48 hours were 0.221/0.249 ug/L, 75/65% and 82.4/94.1%, respectively.
CONCLUSIONS
Serum S-100B protein was an early and useful marker for the prediction of poor neurological outcomes in post-CA patients treated with TH and the optimal sampling times were 24 and 36 hours after ROSC.

Citations

Citations to this article as recorded by

The first national survey on practices of neurological prognostication after cardiac arrest in China, still a lot to do
Lanfang Du, Kang Zheng, Lu Feng, Yu Cao, Zhendong Niu, Zhenju Song, Zhi Liu, Xiaowei Liu, Xudong Xiang, Qidi Zhou, Hui Xiong, Fengying Chen, Guoqiang Zhang, Qingbian Ma
International Journal of Clinical Practice.2021;[Epub] CrossRef
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef

Neurology/Emergency
Acute Physiologic and Chronic Health Examination II and Sequential Organ Failure Assessment Scores for Predicting Outcomes of Out-of-Hospital Cardiac Arrest Patients Treated with Therapeutic Hypothermia: Sung Joon Kim, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Hyuk Jun Yang; Korean J Crit Care Med. 2014;29(4):288-296. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.288

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Abstract PDF: BACKGROUND
The aim of this study was to assess the relationship between acute physiologic and chronic health examination (APACHE) II and sequential organ failure assessment (SOFA) scores and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia (TH).
METHODS
Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between January 2010 and December 2012 were retrospectively evaluated. We captured all components of the APACHE II and SOFA scores over the first 48 hours after intensive care unit (ICU) admission (0 h). The primary outcome measure was in-hospital mortality and the secondary outcome measure was neurologic outcomes at the time of hospital discharge. Receiver-operating characteristic and logistic regression analysis were used to determine the predictability of outcomes with serial APACHE II and SOFA scores.
RESULTS
A total of 138 patients were enrolled in this study. The area under the curve (AUC) for APACHE II scores at 0 h for predicting in-hospital mortality and poor neurologic outcomes (cerebral performance category: 3-5) was more than 0.7, and for SOFA scores from 0 h to 48 h the AUC was less than 0.7. Odds ratios used to determine associations between APACHE II scores from 0 h to 48 h and in-hospital mortality were 1.12 (95% confidence interval [CI], 1.03-1.23), 1.13 (95% CI, 1.04-1.23), and 1.18 (95% CI, 1.07-1.30).
CONCLUSIONS
APACHE II, but not SOFA score, at the time of ICU admission is a modest predictor of in-hospital mortality and poor neurologic outcomes at the time of hospital discharge for patients who have undergone TH after return of spontaneous circulation following OHCA.

Case Report

Neurosurgery
Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction: Jun Young Chang, Jeong Ho Hong, Jin Heon Jeong, Sung Jin Nam, Ji Hwan Jang, Jae Seung Bang, Moon Ku Han; Korean J Crit Care Med. 2014;29(2):93-98. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.93

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Abstract PDF

Decompressive hemicraniectomy followed by subsequent therapeutic hypothermia can reduce mortality in patients with malignant cerebral infarction without significantly increasing risk. We report three cases of malignant cerebral infarction treated with hemicraniectomy followed by hypothermia. Case 1 received elective decompressive surgery and hypothermia. Case 2 developed subsequent cerebral infarction with uncal herniation. Therefore, emergent decompressive surgery and hypothermia was performed in this case. Despite surgery and hyperosmolar therapy, case 3 received hypothermia treatment for refractory increased intracranial pressure. All patients survived with a score of 4 or 5 on the modified Rankin scale. Therefore, we suggest that application of hypothermia after hemicraniectomy is safe and feasible. Several possible modifications can be made to improve the management strategy in order to increase the benefits of hypothermia treatment.

Citations

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Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect
Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi
The Korean Journal of Critical Care Medicine.2015; 30(4): 272. CrossRef

Original Article

The Relation between Neurologic Prognosis and Optic Nerve Sheath Diameter Measured in Initial Brain Computed Tomography of Cardiac Arrest and Hanging Patients: Kun Dong Kim, Hong Joon Ahn, Byul Nim Hee Cho, Sang Min Jeong, Joon Wan Lee, Yeon Ho You, In Sool Yoo, Won Joon Jeong; Korean J Crit Care Med. 2013;28(4):293-299.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.293

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Abstract PDF: BACKGROUND
Early prediction of neurologic outcome is important to patients treated with therapeutic hypothermia after hypoxic brain injury. Hypoxic brain injury patients may have poor neurologic prognosis due to increased intracranial pressure. Increased intracranial pressure can be detected by optic nerve sheath diameter (ONSD) measurement in computed tomography (CT) or ultrasound. In this study, we evaluate the relation between neurologic prognosis and optic nerve sheath diameter measured in brain CT of hypoxic brain injury patients.
METHODS
We analyzed the patient clinical data by retrospective chart review. We measured the ONSD in initial brain CT. We also measured and calculated the gray white matter ratio (GWR) in CT scan. We split the patients into two groups based on neurologic outcome, and clinical data, ONSD, and GWR were compared in the two groups.
RESULTS
Twenty-four patients were included in this study (age: 52.6 +/- 18.3, 18 males). The mean ONSD of the poor neurologic outcome group was larger than that of the good neurologic outcome group (6.07 mm vs. 5.39 mm, p = 0.003). The GWR of the good neurologic outcome group was larger than that of the poor outcome group (1.09 vs. 1.28, p = 0.000). ONSD was a good predictor of neurologic outcome (area under curve: 0.848), and an ONSD cut off > or = 5.575 mm had a sensitivity of 86.7% and a specificity of 77.8%.
CONCLUSIONS
ONSD measured on the initial brain CT scan can predict the neurologic prognosis in cardiac arrest and hanging patients treated with therapeutic hypothermia.

Case Report

Repeated Hypothermia for Rebound Cerebral Edema after Therapeutic Hypothermia in Malignant Cerebral Infarction: Jeong Ho Hong, Jin Heon Jeong, Jun Young Chang, Min Ju Yeo, Han Yeong Jeong, Hee Joon Bae, Moon Ku Han; Korean J Crit Care Med. 2013;28(3):221-224.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.221

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Abstract PDF

Malignant cerebral infarction has a high risk of fatal brain edema and increased intracranial pressure with cerebral herniation causing death. One of the major causes of death is a rebound cerebral edema during rewarming phase. A 66-year-old male patient presented with the right hemiplegia and global aphasia due to malignant cerebral infarction in the whole territory of middle cerebral artery with the occlusion of the proximal internal carotid artery. Being refused decompressive hemicraniectomy, he received the therapeutic hypothermia for 6 days. After rewarming for 6 hours, mentality was suddenly decreased and dilated left pupil. Follow-up CT revealed that midline shifting was more aggravated. We decided on repeated hypothermia for rebound cerebral edema and successfully controlled. We report our experience with repeated hypothermia for rebound cerebral edema following therapeutic hypothermia in malignant cerebral infarction.

Citations

Citations to this article as recorded by

Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect
Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi
The Korean Journal of Critical Care Medicine.2015; 30(4): 272. CrossRef
Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction
Jun Young Chang, Jeong-Ho Hong, Jin-Heon Jeong, Sung-Jin Nam, Ji-Hwan Jang, Jae Seung Bang, Moon-Ku Han
Korean Journal of Critical Care Medicine.2014; 29(2): 93. CrossRef

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