In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 138, No. Suppl_2 ( 2018-11-06)
Abstract:
Introduction: Targeted temperature management (TTM) is a widely accepted neuroprotective strategy in the management of comatose cardiac arrest (CA) survivors. The beneficial impact of TTM on cardiac performance in this population remains debatable. Hypothesis: Mild cooling enhances cardiac performance in arrest survivors undergoing TTM. Methods: We reviewed prospectively collected data on all CA survivors undergoing TTM at our CICU between Jan15 and Jun17. Enrollment was restricted to cases with invasive hemodynamics (iHDs) available at TTM initiation, every 8 hrs at target temperature (32-34°C) and at rewarming completion ( 〉 36°C), unless precluded by mortality. Those with cooling initiated before admission and temperature of 〈 36°C prior to iHDs were excluded. iHDs included temperature (Temp), heart rate (HR), mean blood pressure (MAP), right atrial pressure (RAP), pulmonary wedge pressure (PCWP), systemic vascular resistance (SVR) and Fick Cardiac Index (CI). Left and right ventricular stroke work indices were calculated (LVSWI & RVSWI).We also assessed changes induced by cooling, and overall improvements in cardiac performance and iHDs over time at completion of rewarming controlling for temp change using longitudinal data analysis. Results: 46 arrest survivors with average age of 61 years, 65% male, 83% out-hospital arrest with a shockable rhythm (74%) were evaluated. HR decreased with cooling (p 〈 0.001), to return to baseline after rewarming (p=0.6). MAP, SVR and PCWP decreased by cooling (p 〈 0.001 for all), with sustained improvement after rewarming (p 〈 0.001 for all). LVSWI increased with cooling (p 〈 0.001), with return to baseline after rewarming (p=0.6). Similar findings were encountered with RAP and RVSWI. Conclusion: Mild cooling during TTM improves cardiac performance indices. At TTM completion, there is a sustained decrease in filling pressures without a change in LVSWI indicative of improved contractile performance during cooling.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.138.suppl_2.217
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
1466401-X
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