Unexpected fatal neurological deterioration after successful cardio-pulmonary resuscitation and therapeutic hypothermia

Summary A 77-year-old woman was admitted to the intensive care unit after successful cardiopulmonary resuscitation for out-of-hospital cardiac arrest due to pulseless electrical activity. She was treated with mild therapeutic hypothermia to minimise secondary anoxic brain damage. After a 24 h period...

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Bibliographic Details
Published in:	Resuscitation Vol. 76; no. 1; pp. 142 - 145
Main Authors:	Bergman, R, Tjan, D.H.T, Adriaanse, M.W, van Vugt, R, van Zanten, A.R.H
Format:	Journal Article
Language:	English
Published:	Shannon Elsevier Ireland Ltd 01-01-2008 Elsevier
Subjects:	Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Brain Edema - etiology Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - adverse effects Cerebral herniation Cerebral oedema Emergency Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Fatal Outcome Female Fever Glasgow Coma Scale Heart Arrest - therapy Histopathology Humans Hyperthermia Hypothermia, Induced - adverse effects Hypoxia, Brain - etiology Intensive care medicine Medical sciences Out-of-hospital cardiac arrest Pneumology Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Therapeutic hypothermia Cerebral oedema Histopathology Cardiopulmonary resuscitation Out-of-hospital cardiac arrest Therapeutic hypothermia Hyperthermia Fever Cerebral herniation Nervous system diseases Cardiocirculatory arrest Intensive care Central nervous system Cardiovascular disease Cerebral disorder Encephalon Treatment Deterioration Central nervous system disease Out of hospital Cerebral edema Resuscitation Hypothermia
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Summary:	Summary A 77-year-old woman was admitted to the intensive care unit after successful cardiopulmonary resuscitation for out-of-hospital cardiac arrest due to pulseless electrical activity. She was treated with mild therapeutic hypothermia to minimise secondary anoxic brain damage. After a 24 h period of therapeutic hypothermia with a temperature of 32.5 °C, the patient was rewarmed and sedation discontinued. Neurological evaluation after 24 h revealed a maximum Glasgow Coma Score of E4M4Vt with spontaneous breathing. However the patient developed a fever reaching 39 °C for several hours that was unresponsive to conventional cooling methods. In the subsequent 24 h patient developed apnoea, hypotension and bradycardia with deterioration of the coma score. Diabetes insipidus was confirmed. Cerebral CT was performed which showed diffuse brain oedema with herniation and brainstem compression. The patient died within hours. Autopsy showed massive brain swelling and tentorial herniation. Hyperthermia possibly played a pivotal role in the development of this fatal insult to this vulnerable brain after cardiac arrest and therapeutic hypothermia treatment. The acute histopathological alterations in the brain, possibly caused by the deleterious effects of fever after cardiac arrest in human brain, may be considered a new observation.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0300-9572 1873-1570
DOI:	10.1016/j.resuscitation.2007.06.011