Skip to main content
SpringerLink
Log in

Predictors of external cooling failure after cardiac arrest

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

External cooling is largely employed to induce hypothermia in comatose survivors of cardiac arrest (CA), but can fail to reach the target temperature in a reasonable time. We aimed to assess the rate of failure of external cooling after CA and to determine failure predictors.

Methods

The study was a retrospective review of a prospectively acquired database in the setting of a 24-bed ICU in a university hospital. All consecutive patients admitted for CA from May 2002 to April 2010 and treated by external cooling were considered. Patients who were already hypothermic on admission, patients dying within 24 h, patients cooled by an internal technique and patients in whom hypothermia had not been attempted were not studied. External cooling failure was defined as the inability to reach a temperature below 34 °C during the first 12 h after CA onset.

Results

Among 1,036 patients admitted to the ICU, 594 were included in the analysis and in 191 (32 %) the target temperature could not be achieved within the 12 h following CA. Independent risk factors for external cooling failure were an early coronary angiography intervention (OR 3.75, p < 0.001), a high body weight (OR 1.02 per kilogram, p = 0.007), a high temperature on ICU admission (OR 1.47 per degree, p = 0.001) and a long delay between collapse and the start of cooling (OR 1.15, p = 0.05). Conversely, early haemodialysis (OR 0.27, p < 0.001) and male gender (OR 0.47, p = 0.02) were significantly associated with cooling success.

Conclusion

External cooling failure occurred in nearly one-third of patients with CA and was associated with easily identified risk factors. This emphasizes the interest in early cooling and alternative techniques in these patients.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (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 

  2. Hypothermia after Cardiac 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 

  3. Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, Gabrielli A, Silvers SM, Zaritsky AL, Merchant R, Hoek TLV, Kronick SL (2010) Part 9: post cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122:S768–S786

    Article  PubMed  Google Scholar 

  4. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 81:1305–1352

    Article  PubMed  Google Scholar 

  5. Chenoune M, Lidouren F, Adam C, Pons S, Darbera L, Bruneval P, Ghaleh B, Zini R, Dubois-Randé J-L, Carli P, Vivien B, Ricard J-D, Berdeaux A, Tissier R (2011) Ultrafast and whole-body cooling with total liquid ventilation induces favorable neurological and cardiac outcomes after cardiac arrest in rabbits. Circulation 124:901–911

    Article  PubMed  CAS  Google Scholar 

  6. Che D, Li L, Kopil CM, Liu Z, Guo W, Neumar RW (2011) Impact of therapeutic hypothermia onset and duration on survival, neurologic function, and neurodegeneration after cardiac arrest. Crit Care Med 39:1423–1430

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Bernard SA, Smith K, Cameron P, Masci K, Taylor DM, Cooper DJ, Kelly AM, Silvester W; Rapid Infusion of Cold Hartmanns Investigators (2012) Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest. Crit Care Med 40:747–753

    Article  PubMed  Google Scholar 

  9. Škulec R, Truhlář A, Šeblová J, Dostál P, Černý V (2010) Pre-hospital cooling of patients following cardiac arrest is effective using even low volumes of cold saline. Crit Care 14:R231

    Article  PubMed  Google Scholar 

  10. Merchant RM, Soar J, Skrifvars MB, Silfvast T, Edelson DP, Ahmad F, Huang K-N, Khan M, Vanden Hoek TL, Becker LB, Abella BS (2006) Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 34:1935–1940

    Article  PubMed  Google Scholar 

  11. Bernard SA, Smith K, Cameron P, Masci K, Taylor DM, Cooper DJ, Kelly A-M, Silvester W (2010) Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest : a randomized controlled trial. Circulation 122:737–742

    Article  PubMed  Google Scholar 

  12. Flemming K, Simonis G, Ziegs E, Diewok C, Gildemeister R, Wunderlich C, Strasser RH (2006) Comparison of external and intravascular cooling to induce hypothermia in patients after CPR. Ger Med Sci 4:Doc04

    PubMed  Google Scholar 

  13. Gillies MA, Pratt R, Whiteley C, Borg J, Beale RJ, Tibby SM (2010) Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques. Resuscitation 81:1117–1122

    Article  PubMed  Google Scholar 

  14. Deye N, Group TIS (2010) Interest of endovascular cooling after cardiac arrest. Resuscitation 81:S3

    Article  Google Scholar 

  15. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D’Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D; International Liaison Committee on Resuscitation (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 63:233–249

    Article  PubMed  Google Scholar 

  16. Mongardon N, Dumas F, Ricome S, Grimaldi D, Hissem T, Pene F, Cariou A (2011) Postcardiac arrest syndrome: from immediate resuscitation to long-term outcome. Ann Intensive Care 1:45

    Article  PubMed  Google Scholar 

  17. Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW, Kloeck WGJ, Billi J, Böttiger BW, Morley PT, Nolan JP, Okada K, Reyes C, Shuster M, Steen PA, Weil MH, Wenzel V, Hickey RW, Carli P, Vanden Hoek TL, Atkins D (2003) Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation 108:118–121

    Article  PubMed  CAS  Google Scholar 

  18. Dumas F, Cariou A, Manzo-Silberman S, Grimaldi D, Vivien B, Rosencher J, Empana J-P, Carli P, Mira J-P, Jouven X, Spaulding C (2010) Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Circ Cardiovasc Interv 3:200–207

    Article  PubMed  Google Scholar 

  19. Holzer M (2008) Devices for rapid induction of hypothermia. Eur J Anaesthesiol Suppl 42:31–38

    Article  PubMed  CAS  Google Scholar 

  20. Merchant RM, Becker LB, Abella BS, Asch DA, Groeneveld PW (2009) Cost-effectiveness of therapeutic hypothermia after cardiac arrest. Circ Cardiovasc Qual Outcomes 2:421–428

    Article  PubMed  Google Scholar 

  21. Hoedemaekers CW, Ezzahti M, Gerritsen A, van der Hoeven JG (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 

  22. Howes D, Ohley W, Dorian P, Klock C, Freedman R, Schock R, Krizanac D, Holzer M (2010) Rapid induction of therapeutic hypothermia using convective-immersion surface cooling: safety, efficacy and outcomes. Resuscitation 81:388–392

    Article  PubMed  Google Scholar 

  23. Castrén M, Nordberg P, Svensson L, Taccone F, Vincent J-L, Desruelles D, Eichwede F, Mols P, Schwab T, Vergnion M, Storm C, Pesenti A, Pachl J, Guérisse F, Elste T, Roessler M, Fritz H, Durnez P, Busch H-J, Inderbitzen B, Barbut D (2010) Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation 122:729–736

    Article  PubMed  Google Scholar 

  24. Aggarwal A, Blum A, Schneider DJ, Sobel BE, Dauerman HL (2004) Soluble CD40 ligand is an early initiator of inflammation after coronary intervention. Coron Artery Dis 15:471–475

    Article  PubMed  Google Scholar 

  25. Almagor M, Keren A, Banai S (2003) Increased C-reactive protein level after coronary stent implantation in patients with stable coronary artery disease. Am Heart J 145:248–253

    Article  PubMed  CAS  Google Scholar 

  26. Wolfrum S, Pierau C, Radke PW, Schunkert H, Kurowski V (2008) Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention. Crit Care Med 36:1780–1786

    Article  PubMed  Google Scholar 

  27. Batista LM, Lima FO, Januzzi JL Jr, Donahue V, Snydeman C, Greer DM (2010) Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest. Resuscitation 81:398–403

    Article  PubMed  Google Scholar 

  28. Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW, Callaway C, Clark RSB, Geocadin RG, Jauch EC, Kern KB, Laurent I, Longstreth WT, Merchant RM, Morley P, Morrison LJ, Nadkarni V, Peberdy MA, Rivers EP, Rodriguez-Nunez A, Sellke FW, Spaulding C, Sunde K, Vanden Hoek T (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation 118:2452–2483

    Article  PubMed  Google Scholar 

  29. Laurent I, Adrie C, Cariou A, Chiche J-D, Ohanessian A, Spaulding C, Carli P, Dhainaut J-F, Monchi M (2005) High-volume hemofiltration after out-of-hospital cardiac arrest a randomized study. J Am Coll Cardiol 46:432–437

    Article  PubMed  Google Scholar 

  30. Mongardon N, Perbet S, Lemiale V, Dumas F, Poupet H, Charpentier J, Péne F, Chiche J-D, Mira J-P, Cariou A (2011) Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era. Crit Care Med 39:1359–1364

    Article  PubMed  Google Scholar 

  31. Perbet S, Mongardon N, Dumas F, Bruel C, Lemiale V, Mourvillier B, Carli P, Varenne O, Mira J-P, Wolff M, Cariou A (2011) Early onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis. Am J Respir Crit Care Med 184:1048–1054

    Article  PubMed  Google Scholar 

  32. den Hartog AW, de Pont A-CJ, Robillard LB, Binnekade JM, Schultz MJ, Horn J (2010) Spontaneous hypothermia on intensive care unit admission is a predictor of unfavorable neurological outcome in patients after resuscitation: an observational cohort study. Crit Care 14:R121

    Article  Google Scholar 

  33. Lyon RM, Richardson SE, Hay AW, Andrews PJD, Robertson CE, Clegg GR (2010) Esophageal temperature after out-of-hospital cardiac arrest: an observational study. Resuscitation 81:867–871

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

The authors have not disclosed any potential conflicts of interest. Financial support was provided solely from departmental resources.

Author information

Authors and Affiliations

  1. Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca HĂ´tel-Dieu, Assistance Publique des HĂ´pitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France

    Sylvie Ricome, Nicolas Mongardon, Jérôme Fichet, Frédéric Pène, Benjamin Zuber, Julien Charpentier, Jean-Daniel Chiche, Jean-Paul Mira & Alain Cariou

  2. INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, 56 rue Leblanc, Paris, France

    Florence Dumas & Alain Cariou

  3. Faculté de Médecine, Paris Cité Sorbonne, Université Paris Descartes, 15 rue de l’Ecole de Médecine, 75006, Paris, France

    Sylvie Ricome, Nicolas Mongardon, Jérôme Fichet, Frédéric Pène, Benjamin Zuber, Jean-Daniel Chiche, Jean-Paul Mira & Alain Cariou

  4. Department of Emergency Medicine, Cochin Hospital, Groupe Hospitalier Cochin Broca HĂ´tel-Dieu, Assistance Publique des HĂ´pitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France

    Florence Dumas

  5. Department of Cardiology, Cochin Hospital, Groupe Hospitalier Cochin Broca HĂ´tel-Dieu, Assistance Publique des HĂ´pitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France

    Olivier Varenne

  6. SAMU 75, Assistance Publique des Hôpitaux de Paris, Necker Hospital, 161 rue de Sèvres, 75015, Paris, France

    Benoît Vivien

Authors
  1. Sylvie Ricome
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florence Dumas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas Mongardon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Varenne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. JĂ©rĂ´me Fichet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frédéric Pène
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Benjamin Zuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Benoît Vivien
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Julien Charpentier
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jean-Daniel Chiche
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jean-Paul Mira
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alain Cariou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sylvie Ricome.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ricome, S., Dumas, F., Mongardon, N. et al. Predictors of external cooling failure after cardiac arrest. Intensive Care Med 39, 620–628 (2013). https://doi.org/10.1007/s00134-012-2794-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-012-2794-7

Keywords

Search

Navigation