Skip to main content
SpringerLink
Log in

Therapeutische Hypothermie

Therapeutic hypothermia

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Mildes Kühlen von erfolgreich Reanimierten bleibt die bislang einzige therapeutische Intervention, für die in randomisierten, kontrollierten Studien ein bedeutsamer Vorteil beschrieben wurde, zumindest für ausgewählte Patienten. Mit Kühlen stieg der Anteil der ohne schwere neurologische Schädigung Überlebenden um 15 absolute Prozent. Therapeutisches Kühlen wird maßgeblich auch von den Leitlinien des ERC („European Research Counsil“) empfohlen, allerdings ist die Datenlage nicht immer eindeutig, insbesondere sind viele Details nach wie vor unscharf oder gar nicht definiert.

Abstract

Mild hypothermia remains the only therapeutic intervention with fair evidence of improving outcome after successful cardiopulmonary resuscitation (CPR). Two randomized controlled trials reported a clinically relevant increase in survival without severe neurological impairment of 15% at least for selected patients. International guidelines, including those from the European Resuscitation Council (ERC), recommend therapeutic hypothermia, but the devil is in the details.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Abou-Chebl A, DeGeorgia MA, Andrefsky JC, Krieger DW (2004) Technical refinements and drawbacks of a surface cooling technique for the treatment of severe acute ischemic stroke. Neurocrit Care 1:131–143

    Article  PubMed  Google Scholar 

  2. Arrich J (2007) Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 35:1041–1047

    Article  PubMed  Google Scholar 

  3. Bernard S (1996) Induced hypothermia in intensive care medicine. Anaesth Intensive Care 24:382–388

    PubMed  CAS  Google Scholar 

  4. Bernard SA, Gray TW, Buist MD et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563

    Article  PubMed  Google Scholar 

  5. Bernard S, Buist M, Monteiro O, Smith K (2003) Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 56:9–13

    Article  PubMed  Google Scholar 

  6. Bossaert L, O’Connor RE, Arntz HR et al (2010) Part 9: Acute coronary syndromes: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation [Suppl 1] 81:e175–e212

  7. Bro-Jeppesen J, Kjaergaard J, Horsted TI et al (2009) The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest. Resuscitation 80:171–176

    Article  PubMed  Google Scholar 

  8. Bruel C, Parienti JJ, Marie W et al (2008) Mild hypothermia during advanced life support: a preliminary study in out-of-hospital cardiac arrest. Crit Care 12:R31

    Article  PubMed  Google Scholar 

  9. Canadian Association of Emergency Physicians (2006) Guidelines for the use of hypothermia after cardiac arrest. CJEM 8:106–108

    Google Scholar 

  10. Cheung KW, Green RS, Magee KD (2006) Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients. CJEM 8:329–337

    PubMed  Google Scholar 

  11. Cronberg T, Lilja G, Rundgren M et al (2009) Long-term neurological outcome after cardiac arrest and therapeutic hypothermia. Resuscitation 80(10):1119–1123

    Article  PubMed  Google Scholar 

  12. Deakin CD, Nolan JP, Soar J et al (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 81(10):1305–1352

    Article  PubMed  Google Scholar 

  13. Diringer MN (2004) Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 32:559–564

    Article  PubMed  Google Scholar 

  14. Dixon SR, Whitbourn RJ, Dae MW et al (2002) Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction. J Am Coll Cardiol 40:1928–1934

    Article  PubMed  Google Scholar 

  15. Erickson RS, Kirklin SK (1993) Comparison of ear-based, bladder, oral, and axillary methods for core temperature measurement. Crit Care Med 21:1528–1534

    Article  PubMed  CAS  Google Scholar 

  16. Fink K, Schwab T, Bode C, Busch HJ (2008) Endovascular or surface cooling: therapeutic hypothermia after cardiac arrest. Anaesthesist 57:1155–1160

    Article  PubMed  CAS  Google Scholar 

  17. Flint AC, Hemphill JC, Bonovich DC (2007) Therapeutic hypothermia after cardiac arrest: performance characteristics and safety of surface cooling with or without endovascular cooling. Neurocrit Care 7:109–118

    Article  PubMed  Google Scholar 

  18. Frank SM, Fleisher LA, Breslow MJ et al (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:1127–1134

    Article  PubMed  CAS  Google Scholar 

  19. Fredriksson M, Herlitz J, Nichol G (2003) Variation in outcome in studies of out-of-hospital cardiac arrest: a review of studies conforming to the Utstein guidelines. Am J Emerg Med 21:276–281

    Article  PubMed  Google Scholar 

  20. Fredriksson M, Aune S, Thoren AB, Herlitz J (2006) In-hospital cardiac arrest – an Utstein style report of seven years experience from the Sahlgrenska University Hospital. Resuscitation 68:351–358

    Article  PubMed  Google Scholar 

  21. Gentilello LM, Jurkovich GJ, Stark MS et al (1997) Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg 226:439–447

    Article  PubMed  CAS  Google Scholar 

  22. Guyatt G, Schunemann HJ, Cook D et al (2004) Applying the grades of recommendation for antithrombotic and thrombolytic therapy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:179S–187S

    Article  PubMed  Google Scholar 

  23. Hachimi-Idrissi S, Corne L, Ebinger G et al (2001) Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 51:275–281

    Article  PubMed  CAS  Google Scholar 

  24. Haugk M, Sterz F, Grassberger M et al (2007) Feasibility and efficacy of a new non-invasive surface cooling device in post-resuscitation intensive care medicine. Resuscitation 75:76–81

    Article  PubMed  Google Scholar 

  25. Hay AW, Swann DG, Bell K et al (2008) Therapeutic hypothermia in comatose patients after out-of-hospital cardiac arrest. Anaesthesia 63:15–19

    Article  PubMed  CAS  Google Scholar 

  26. Hemmen TM, Raman R, Guluma KZ et al (2010) Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L): final results. Stroke 41(10):2265–2270

    Article  PubMed  Google Scholar 

  27. Hinz J, Rosmus M, Popov A et al (2007) Effectiveness of an intravascular cooling method compared with a conventional cooling technique in neurologic patients. J Neurosurg Anesthesiol 19:130–135

    Article  PubMed  Google Scholar 

  28. Hoedemaekers CW, Ezzahti M, Gerritsen A, Hoeven JG van der (2007) Comparison of cooling methods to induce and maintain normo- and hypothermia in intensive care unit patients: a prospective intervention study. Crit Care 11:R91

    Article  PubMed  Google Scholar 

  29. Hoehn T, Hansmann G, Buhrer C et al (2008) Therapeutic hypothermia in neonates. Review of current clinical data, ILCOR recommendations and suggestions for implementation in neonatal intensive care units. Resuscitation 78:7–12

    Article  PubMed  Google Scholar 

  30. Holzer M, Behringer W, Janata A et al (2005) Extracorporeal venovenous cooling for induction of mild hypothermia in human-sized swine. Crit Care Med 33:1346–1350

    Article  PubMed  Google Scholar 

  31. Hovdenes J, Laake JH, Aaberge L et al (2007) Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock. Acta Anaesthesiol Scand 51:137–142

    Article  PubMed  CAS  Google Scholar 

  32. Hutchison JS, Ward RE, Lacroix J et al (2008) Hypothermia therapy after traumatic brain injury in children. N Engl J Med 358:2447–2456

    Article  PubMed  CAS  Google Scholar 

  33. Hypothermia after Cardia Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556

    Article  Google Scholar 

  34. Janata A, Weihs W, Bayegan K et al (2008) Therapeutic hypothermia with a novel surface cooling device improves neurologic outcome after prolonged cardiac arrest in swine. Crit Care Med 36:895–902

    Article  PubMed  Google Scholar 

  35. Keller E, Imhof HG, Gasser S et al (2003) Endovascular cooling with heat exchange catheters: a new method to induce and maintain hypothermia. Intensive Care Med 29:939–943

    PubMed  Google Scholar 

  36. Kilgannon JH, Roberts BW, Stauss M et al (2008) Use of a standardized order set for achieving target temperature in the implementation of therapeutic hypothermia after cardiac arrest: a feasibility study. Acad Emerg Med 15:499–505

    Article  PubMed  Google Scholar 

  37. Kim F, Olsufka M, Longstreth WT et al (2007) Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation 115:3064–3070

    Article  PubMed  Google Scholar 

  38. Kliegel A, Losert H, Sterz F et al (2005) Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest – a feasibility study. Resuscitation 64:347–351

    Article  PubMed  Google Scholar 

  39. Koreny M, Sterz F, Uray T et al (2009) Effect of cooling after human cardiac arrest on myocardial infarct size. Resuscitation 80:56–60

    Article  PubMed  Google Scholar 

  40. Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334:1209–1215

    Article  PubMed  CAS  Google Scholar 

  41. Laurent I, Adrie C, Vinsonneau C et al (2005) High-volume hemofiltration after out-of-hospital cardiac arrest: a randomized study. J Am Coll Cardiol 46:432–437

    Article  PubMed  Google Scholar 

  42. Lefrant JY, Muller L, La Coussaye JE de et al (2003) Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med 29:414–418

    PubMed  Google Scholar 

  43. Merchant RM, Abella BS, Peberdy MA et al (2006) Therapeutic hypothermia after cardiac arrest: unintentional overcooling is common using ice packs and conventional cooling blankets. Crit Care Med 34:S490–S494

    Article  PubMed  Google Scholar 

  44. Moran JL, Peter JV, Solomon PJ et al (2007) Tympanic temperature measurements: are they reliable in the critically ill? A clinical study of measures of agreement. Crit Care Med 35:155–164

    Article  PubMed  Google Scholar 

  45. Morrison LJ, Deakin CD, Morley PT et al (2010) Part 8: Advanced life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 122:S345–S421

    Article  PubMed  Google Scholar 

  46. O’Connor RE, Bossaert L, Arntz HR et al (2010) Part 9: Acute coronary syndromes: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 122:S422–S465

    Article  Google Scholar 

  47. Oddo M, Ribordy V, Feihl F et al (2008) Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study. Crit Care Med 36:2296–2301

    Article  PubMed  Google Scholar 

  48. Oddo M, Rossetti AO (2011) Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care 17(3):254–259

    Article  PubMed  Google Scholar 

  49. Oksanen T, Tiainen M, Skrifvars MB et al (2009) Predictive power of serum NSE and OHCA score regarding 6-month neurologic outcome after out-of-hospital ventricular fibrillation and therapeutic hypothermia. Resuscitation 80:165–170

    Article  PubMed  Google Scholar 

  50. Pechlaner C, Joannidis M (2009) Therapeutische Hypothermie. Intensivmed 46:211–219

    Article  Google Scholar 

  51. Pichon N, Amiel JB, Francois B et al (2007) Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system. Crit Care 11:R71

    Article  PubMed  Google Scholar 

  52. Polderman KH (2008) Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet 371:1955–1969

    Article  PubMed  Google Scholar 

  53. Polderman KH (2009) Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 37:S186–S202

    Article  PubMed  Google Scholar 

  54. Polderman KH, Callaghan J (2006) Equipment review: cooling catheters to induce therapeutic hypothermia? Crit Care 10:234

    Article  PubMed  Google Scholar 

  55. Polderman KH, Tjong Tjin JR, Peerdeman SM et al (2002) Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury. Intensive Care Med 28:1563–1573

    Article  PubMed  Google Scholar 

  56. Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes AR (2005) Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med 33:2744–2751

    Article  PubMed  Google Scholar 

  57. Rittenberger JC, Guyette FX, Tisherman SA et al (2008) Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest. Resuscitation 79:198–204

    Article  PubMed  Google Scholar 

  58. Rittenberger JC, Kelly E, Jang D et al (2008) Successful outcome utilizing hypothermia after cardiac arrest in pregnancy: a case report. Crit Care Med 36:1354–1356

    Article  PubMed  Google Scholar 

  59. Schmied H, Kurz A, Sessler DI et al (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347:289–292

    Article  PubMed  CAS  Google Scholar 

  60. Schmutzhard E, Engelhardt K, Beer R et al (2002) Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study. Crit Care Med 30:2481–2488

    Article  PubMed  Google Scholar 

  61. Schwab S, Georgiadis D, Berrouschot J et al (2001) Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 32:2033–2035

    Article  PubMed  CAS  Google Scholar 

  62. Shankaran S, Laptook AR, Ehrenkranz RA et al (2005) Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 353:1574–1584

    Article  PubMed  CAS  Google Scholar 

  63. Steinberg GK, Ogilvy CS, Shuer LM et al (2004) Comparison of endovascular and surface cooling during unruptured cerebral aneurysm repair. Neurosurgery 55:307–314

    Article  PubMed  Google Scholar 

  64. Sund-Levander M, Forsberg C, Wahren LK (2002) Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review. Scand J Caring Sci 16:122–128

    Article  PubMed  Google Scholar 

  65. Sydenham E, Roberts I, Alderson P (2009) Hypothermia for traumatic head injury. Cochrane Database Syst Rev 1:CD001048

    PubMed  Google Scholar 

  66. Tiainen M, Roine RO, Pettila V, Takkunen O (2003) Serum neuron-specific enolase and S-100B protein in cardiac arrest patients treated with hypothermia. Stroke 34:2881–2886

    Article  PubMed  CAS  Google Scholar 

  67. Tiainen M, Poutiainen E, Kovala T et al (2007) Cognitive and neurophysiological outcome of cardiac arrest survivors treated with therapeutic hypothermia. Stroke 38(8):2303–2308

    Article  PubMed  Google Scholar 

  68. Tiainen M, Parikka HJ, Makijarvi MA et al (2009) Arrhythmias and heart rate variability during and after therapeutic hypothermia for cardiac arrest. Crit Care Med 37:403–409

    Article  PubMed  Google Scholar 

  69. Tieu BH, Holcomb JB, Schreiber MA (2007) Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg 31:1055–1064

    Article  PubMed  Google Scholar 

  70. Tomte O, Draegni T, Mangschau A et al (2011) A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors. Crit Care Med 39:443–449

    Article  PubMed  Google Scholar 

  71. Tsuei BJ, Kearney PA (2004) Hypothermia in the trauma patient. Injury 35:7–15

    Article  PubMed  Google Scholar 

  72. Uray T, Malzer R (2008) Out-of-hospital surface cooling to induce mild hypothermia in human cardiac arrest: a feasibility trial. Resuscitation 77:331–338

    Article  PubMed  Google Scholar 

  73. Wolff B, Machill K, Schumacher D et al (2009) Early achievement of mild therapeutic hypothermia and the neurologic outcome after cardiac arrest. Int J Cardiol 133:223–228

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, A-6020, Innsbruck, Österreich

    C. Pechlaner &  M. Joannidis

Authors
  1. C. Pechlaner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Joannidis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Joannidis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pechlaner, C., Joannidis, M. Therapeutische Hypothermie. Intensivmed 48, 443–454 (2011). https://doi.org/10.1007/s00390-011-0307-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00390-011-0307-5

Schlüsselwörter

Keywords

Search

Navigation