Therapeutic hypothermia in adult cardiac arrest because of drowning

• Published in: Acta anaesthesiologica Scandinavica Vol. 56; no. 1; pp. 116 - 123
• Main Authors: CHOI, S. P., YOUN, C. S., PARK, K. N., WEE, J. H., PARK, J. H., OH, S. H., KIM, S. H., KIM, J. Y.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-01-2012; Blackwell
• Subjects: Adolescent; Adult; Advanced Cardiac Life Support; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Temperature; Cardiopulmonary Resuscitation; Emergency Medical Services; Evoked Potentials, Somatosensory - physiology; Female; Heart Arrest - etiology; Heart Arrest - therapy; Humans; Hypothermia, Induced; Length of Stay; Male; Medical sciences; Middle Aged; Near Drowning - therapy; Nervous System Diseases - etiology; Neurologic Examination; Prognosis; Seizures - etiology; Survival; Treatment Outcome; Young Adult; Cardiovascular disease; Anesthesia; Cardiocirculatory arrest; Drowning; Hypothermia
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2011.02562.x

Background
Therapeutic hypothermia in adult victims who suffer cardiac arrest following drowning has been applied in only a small number of cases. In the last 4 years, we have employed therapeutic hypothermia to decrease hypoxia‐induced brain injury in these patients. The purpose of the present study was to report the results of the treatment of these patients.
Methods
This study investigated the utilisation of therapeutic hypothermia on consecutive patients with cardiac arrest because of drowning between 2005 and 2008. The study was conducted retrospectively, collecting data by reviewing medical records. Hypothermia, with a target temperature of 32–34°C, was induced for 24 h. Neurological outcomes were classified using the cerebral performance categories (CPCs). The primary outcome was neurological function at discharge.
Results
Twenty patients were treated with therapeutic hypothermia. Four patients (20%) exhibited a favourable neurological outcome (CPC 1–2). Two patients (10%) remained in a vegetative state at discharge (CPC 4), and 14 patients (70%) died (CPC 5). The most common complications during therapeutic hypothermia were pancreatitis and rhabdomyolysis. A longer duration of advanced cardiac life support (P = 0.035), an absence of motor response to pain after 3 days (P = 0.003), an abnormal brain imaging (P = 0.005) and a lack of cortical response to somatosensory evoked potential (P = 0.008) were related to an unfavourable outcome (CPC 3–5).
Conclusion
The present study did not demonstrate an advantage of therapeutic hypothermia in adult cardiac arrest after drowning compared with previous studies treated with conventional therapy. Further prospective studies are needed to evaluate the effects of therapeutic hypothermia.