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Introduction: Cardiac arrest (CA), which occurs outside hospital conditions, is one of the leading causes of death in developed countries and remains responsible for high mortality and morbidity even after successful resuscitation. Hypothermia Therapy (TH) is one of the available therapeutic options aimed at minimizing one of the mechanisms responsible for Post Cardio Respiration Syndrome (PCRS), brain injury arrest after a cardiopulmonary arrest.
Objective: The aim of this study is to clarify the significance of TH after cardiac arrest, in critically ill patients.
Material and Methods: A bibliographic review of the literature, mobilizing the descriptors "Therapeutic hypothermia", "Post cardiopulmonary arrest" and "Critically ill patients". Ten conceivable databases were selected, between 2014-2020, and seven studies were included for analysis.
Results and Discussion: It was found that there are some controversial results. Studies comparing the effects of TH with normothermia have shown similar results regarding neurological recovery, although TH may reduce oxidative damage in some studies. Three of the studies show some beneficial effects, but one shows that these effects will only be beneficial in younger years, in the shortest possible time to ROSC and at the rhythm of CA in ventricular fibrillation. One of the studies showed no beneficial effects on the use of TH.
Conclusion: It can be concluded that although part of the clinical practice has existed for more than a decade and recommendations for use in all patients after ROSC exist, there is considerable controversy and questions about various aspects of implementation. There are still some questions to answer. However, some studies also show good effects of TH (32º-34º) and normothermia (36º).
Mooney MR, Unger BT, Boland LL, Burke MN, Kebed KY, Graham KJ, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest: evaluation of a regional system to increase access to cooling. Circulation. 2011;124:206-14.
McNally B, Robb R, Mehta M, et al. Centers for disease control and prevention. Out-of-hospital cardiac arrest surveillance-Cardiac Arrest Registry to Enhance Survival (CARES), United States. MMWR Surveill Summ, 2011;60:1-19.
Silverman M, Scirica B. Cardiac arrest and therapeutic hypothermia. Trends in Cardiovascular Medicine. 2016;26:337-344.
Wolff B, Machill K, Schumacher D, SchulzkiI W. Early achievement of mild therapeutic hypothermia and the neurologic outcome after cardiac arrest. Int J. Cardiol. 2009;133:223-8.
Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004;30:2126-8.
Peberdy M, Callaway C, Neumar R, et al. Post-cardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(3):768-86.
Swedish Council of CPR; (2011). Available:http://www.hlr.nu/fakta-riktlinjer/ Accessed July 2019.
Chiota N, Freeman W, Barrett K. Earlier hypothermia attainment is associated with improved outcomes after cardiac arrest. J Vasc Interv Neurol. 2011; 4:14-7.
Samaniego E, Persoon S, Wijman C. Prognosis after cardiac arrest and hypothermia: a new paradigm. Curr Neurol Neurosci Rep. 2011;11:111.
Van LP. Near-death experiences: The experience of the self as real and not as an illusion. Ann N Y Acad Sci. 2011;1234:19-28.
American Heart Association Cardiac Arrest Survival Summit. Circulation. 2011;123: 2898-2910.
Callaway C, Donnino M, Fink E, Geocadin R, Golan E, Kern K, et al. Part 8: Post-cardiac arrest care: 2015 American Heart Association Guidelines Update for Cardio- pulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(2):465-82.
Ketilsdottir A, Albertsdottir H, Akadottir S, Gunnarsdottir T, Jonsdottir H. The experience of sudden cardiac arrest: Becoming reawakened to life. Eur. J. Cardiovasc. Nurs; 2013. Available:http://dx.doi.org/10.1177/1474515113504864
Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369:2197-206.
Lascarrou J, Hamid M, Merdji, et al. For the CRICS-TRIGGERSEP Group. Targeted temperature management for cardiac arrest with nonshockable rhythm. The new England Journal of Medicine. 2019;381:2327-2337, DOI: 10.1056/NEJMoa1906661
Mendes A, Fracolli L. Revisão sistemática de literatura e metassíntese qualitativa: Considerações sobre sua aplicação na pesquisa em enfermagem. Texto Contexto Enfermagem. 2008;17(4):771-778.
Benefield L. Implementing evidence-based practice in home care. Home Healthcare Nurse. 2003;21:804-811.
Kim J, Nagy Á, Putzu A, Belletti A. et al. Therapeutic hypothermia in critically Ill patients: A systematic review and meta-analysis of high quality randomized trials. Crit Care Med. 2020;48(7):1047-1054. DOI: 10.1097/CCM.0000000000004364
Hackenhaar F, Medeiros T, Heemann F, et al. Therapeutic hypothermia reduces oxidative damage and alters antioxidant defenses after cardiac arrest. Oxidative Medicine and Cellular Longevity, Article ID 8704352; 2017 Available:https://doi.org/10.1155/2017/8704352.
Dumas F, Cariou A, Bougouin W. Therapeutic hypothermia after cardiac arrest. JAMA. 2017;317(6):644, DOI: 10.1001/jama.2016.19829
Ruivo C, Jesus C, Morais J, Viana P. Predictors of death among cardiac arrest patients after therapeutic hypothermia: A non-tertiary care center's initial experience. Revista Portuguesa de Cardiologia. 2016;35(7):423-431.
Arrich J, Holzer M, Havel C, Müllner M, Herkner H. Cooling the body after resuscitation following cardiac arrest. Cochrane Trusted Evidence. Informed decisions. Better health; 2016.
Alshimemeri A. Therapeutic hypothermia after cardiac arrest. Annals of Cardiac Anesthesia. 2014;17(4): 285-291.
Tisherman S. Targeted temperature management after cardiac arrest: When, how deep, how long?JTD. Journal Toracic Disesae. 2017;9(12).
Park J, Wee J, Choi S, Oh J, Cheol S. Assessment of serum biomarkers and coagulation/fibrinolysis markers for prediction of neurological outcomes of out of cardiac arrest patients treated with therapeutic hypothermia. Clinical and Experimental Emergency Medicine; 2019. Available:https://doi.org/10.15441/ceem.17.273.
Alkadri M, Peters M, Katz M, White C. State-of-the-art paper: Therapeutic hypothermia in out of hospital cardiac arrest survivors. Catheter Cardiovasc Interv. 2013;82:482-90.
Neumar RW, Barnhart J, Berg R, Chan P, Geocadin R, Luepker R. American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Critical Care, Perioperative, and Resuscitation; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Quality of Care and Outcomes Research; Advocacy Coordinating Committee, et al. Implementation strategies for improving survival after out-of-hospital cardiac arrest in the United States: Consensus recommendations from the 2009; 2011.
Cariou J, Payen F, Asehnounen K, et al. Targeted temperature management in the ICU. Guidelines from a French expert panel. Anesthesia Critical Care and Pain Medicine; 2018 Available:https://doi.org/10.1016/j.accpm.2017.06.003, 37(5)481-491
Pinto S. Hipotermia terapêutica na paragem cárdio-respiratória instituto de ciências biomédicas abel Salazar. Mestrado integrado em medicina. Porto; 2012.
Arrich J, Holzer M, Havel C, et al. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev. 2012;9.
Brannstrom M, Niederbach C, Rodin A.. Experiences of surviving a cardiac arrest after therapeutic hypothermia treatment. An interview study. International Emergency Nursing. 2018;36:34-38.
Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, GB Smith, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010;81:1305-1352.
Tomte O, Andersen G, Jacobsen D, Daegni T, Auestad B, Sunde K. Strong and weak aspects of an established post-resuscitation treatment protocol-A five-year observational study. Resuscitation. 2011; 82:1186-1193.
Polderman K. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009;37(7): 186-S202.
Busch M, Soreide E. Should advanced age be a limiting factor in providing therapeutic hypothermia to cardiac arrest survivors? A single-center observational study; 2010. PMID:24716885. DOI: 10.1089/ther.2010.0006