Statistical modeling in pharmaceutical research and development.
Therapeutic hypothermia for postresuscitation syndrome and lactate levels
1. THERAPEUTIC
HYPOTHERMIA FOR
POSTRESUSCITATION
SYNDROME AND LACTATE
LEVELS
Sule AKIN, Assoc.Prof, MD
Baskent University School of Medicine
Anestehsiology and Critical Care Department
Adana - TURKEY
2nd
World Congress on BIOMARKERS & CLINICAL RESEARCH
Baltimore, Maryland , USA. – 13 September 2011
13. N Engl J Med 2002 Feb 21;346(8):557-63
Treatment of comatose survivors of out-of-hospital
cardiac arrest with induced hypothermia.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W,
Guttridge G, Smith K.
N Engl J Med 2002 Feb 21;346(8):549-56
Mild therapeutic hypothermia to improve the
neurologic outcome after cardiac arrest.
Hypothermia after Cardiac Arrest Study Group
(HACA).
Resuscitation 2001 Dec;51(3):275-81
Mild hypothermia induced by a helmet device: a
clinical feasibility study.
Hachimi-Idrissi S, Corne L, Ebinger G, Michotte Y,
Huyghens L.
14. CHAIN OF SURVIVAL
“Chain of Survival Concept”
Circulation 83: 1832-1847, 1991
Resuscitation 46: 29-71, 2000
18. European Resuscitation Council Guidelines for Resuscitation
2010 Section 1. Executive summary
Jerry P. Nolana, Jasmeet Soarb, David A. Zidemanc, Dominique
Biarentd, Leo L. Bossaerte, Charles Deakinf, Rudolph W. Kosterg,
Jonathan Wyllieh, Bernd Böttigeri, on behalf of the ERC Guidelines
Writing Group1
Therapeutic Hypothermia
There is good evidence supporting the use of induced hypothermia in comatose survivors of out-of-
hospital cardiac arrest caused by VF. One randomised trial704 and a pseudorandomised trial669
demonstrated improved neurological outcome at hospital discharge or at 6 months in comatose patients
after out-of-hospital VF cardiac arrest. Cooling was initiated within minutes to hours after ROSC and a
temperature range of 32–34 C was◦ maintained for 12–24 h. Two studies with historical control groups
showed improvement in neurological outcome after therapeutic hypothermia for comatose survivors of
VF cardiac arrest.705–707 Extrapolation of these data to other cardiac arrests (e.g., other initial rhythms,
in-hospital arrests, paediatric patients) seems reasonable but is supported by only lower level data.
Out-of-hospital CPR, In –hospital CPR
VF, PVT, Asistoly, PEA
First 6 hours, 32-34 °C
For 12-24 hours
19. TH – TO WHOM WE CAN’T
APPLY?• Awake patients
• Myoclonus, status epilepticus
• Severe coagulopathy and active
bleeding
• Haemodynamic instability
• Resistant arrhythmia
• Septic shock
• Delayed cases ( >12 hours)
• Suspicious intracranial
hemorrhage
20. TH – ADVERSE EFFECTS
CARDIVASCULA
R
HEMATOLOGIC IMMUNOLOGIC METABOLIC
- Arrhythmia -Platelet
dysfunction
-Coagulopat
hy
-Neutrophil
dysfunction
- Infection
↑
-Hypocalemia
-Hyperglisemi
a
- leusİ
-
Pancreatitis
• Increases due to cooling duration
and intensity