Skip to content

Advertisement

You're viewing the new version of our site. Please leave us feedback.

Learn more

BMC Emergency Medicine

Open Access

Guidelines update

  • Oktay Demirkiran1
BMC Emergency Medicine201515(Suppl 1):A15

https://doi.org/10.1186/1471-227X-15-S1-A15

Published: 24 June 2015

In cardiac arrest patients the primary goal is to restart the heart, return the patient to life, and keep the brain intact. In 1960 a landmark article described the outcome in CPR [1]. In 1964 Peter Safar published the first integrated approach to cardiac arrest, and recommended therapeutic hypothermia (TH) for support recovery [2]. These two studies merged in the first American Heart Association guidelines for the treatment of cardiac arrest patients [3]. The most recent update of the ERC and American Heart Association guidelines were published in November 2010. The use of TH in cardiac arrest patients developed after two cornerstone studies which showed good neurological outcome when the body temperature decreased to 32 to 34°C after out-of-hospital cardiac arrest [4, 5]. Hypothermia can prevent or reduce cellular damage in the post-cardiac arrest period [6]. Current resuscitation guidelines recommend use of TH as soon as possible following return of spontaneous circulation [7]. Most TTM protocols call for induction with cold intravenous saline and surface cooling with cold packs while TH devices are being applied. Since then TTM of 32 to 34°C for 12 to 24 hours has been recommended as part of post-resuscitation care by international guidelines. Frydland and colleagues assessed mild hypothermia in 12 studies in patients with out-of-hospital cardiac arrest and nonshockable rhythms as an initial one [8]. TTM has been recommended for nonshockable rhythms [9]. Some observational studies supported the use of TTM in out-of-hospital cardiac arrest and initial nonshockable rhythms [10, 11].

The new resuscitation guidelines will represent the most recent and comprehensive analysis of intubation or supraglottic airway devices, mechanical devices, adrenaline use, telephone CPR, hypothermia/TTM, early PCI, and post-arrest care. In the new guidelines in 2015 there may be answers for the optimal temperature target, duration of TH, and rates of cooling and rewarming for post arrest.

Financial disclosure

OD has received speaker’s reimbursement from C. R. BARD.

Authors’ Affiliations

(1)
Department of Anaesthesiology and Intensive Care, Istanbul University Cerrahpasa Medical School Hospital

References

  1. Kouwenhoven WB, Jude JR, Knickerbocker CG: Closed chest cardiac massage. JAMA. 1960, 173: 1064-7. 10.1001/jama.1960.03020280004002.View ArticlePubMedGoogle Scholar
  2. Safar PJ: Community wide cardiopulmonary resuscitation. J Iowa Med Soc. 1964, 54: 629-35.PubMedGoogle Scholar
  3. Statement by the Ad Hoc Committee on Cardiopulmonary Resuscitation of the Division of Medical Sciences National Academy of Sciences–National Research Council: Cardiopulmonary resuscitation. JAMA. 1966, 198: 372-9.View ArticleGoogle Scholar
  4. The Hypothermia After Cardiac Arrest Study Group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002, 346: 549-56.View ArticleGoogle Scholar
  5. Bernard SA, Gray TW, Busit MD, et al: Treatment of comatose survivors of out of hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002, 346: 557-63. 10.1056/NEJMoa003289.View ArticlePubMedGoogle Scholar
  6. Polderman KM: Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009, 37 (July 7 Suppl): S186-202.View ArticlePubMedGoogle Scholar
  7. Nolan JP, Morley PT, TL Hack Vanden, Hickeg RW: Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the international liaison committee on resuscitation. Circulation. 2003, 108: 118-21. 10.1161/01.CIR.0000079019.02601.90.View ArticlePubMedGoogle Scholar
  8. Frydland M, Kjaergaard J, Erlinge D, et al: Target temperature management of 33C and 36 C in patients with out-of-hospital cardiac arrest with initial non-shockable rhythm – a TTM sub-study. Resuscitation. 2015, 89: 142-8.View ArticlePubMedGoogle Scholar
  9. Deakin CD, Nolan JP, Soar J, et al: European Resuscitation Council guidelines for resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010, 81: 1305-52. 10.1016/j.resuscitation.2010.08.017.View ArticlePubMedGoogle Scholar
  10. Arrich J, European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group: Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med. 2007, 35: 1401-7.View ArticleGoogle Scholar
  11. Testori C, Sterz F, Behringer W, et al: Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms. Resuscitation. 2011, 82: 1162-7. 10.1016/j.resuscitation.2011.05.022.View ArticlePubMedGoogle Scholar

Copyright

© Demirkiran; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement