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Surface Cooling after Cardiac Arrest: Effectiveness, Skin Safety, and Adverse Events in Routine Clinical Practice

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Abstract

Background

Effectiveness of cooling and adverse events (AEs) involving skin have not been intensively evaluated in cardiac arrest survivors treated with therapeutic hypothermia (TH) when induced and maintained with a servomechanism-regulated surface cooling system.

Methods

Retrospective review of sixty-nine cardiac arrest survivor-events admitted from April 2006–September 2008 who underwent TH using the Medivance Arctic Sun Temperature Management System. A TH database and medical records were reviewed, and nursing interviews conducted. Primary endpoint was time from initiation to target temperature (TT; 32–34°C). Secondary endpoints were cooling rate, percentage of hypothermia maintenance phase at TT, effect of body-mass index (BMI) on rate of cooling, and AEs.

Results

Mean time to the target temperature (TT) was 2.78 h; 80% of patients achieved TT within 4 h; all did within 8 h. Patients were at TT for 96.7% of hypothermia maintenance; 17% of patients had >1 hourly temperature measurement outside TT range. Mean cooling rate during induction phase was 1.1°C/h, and was not associated with BMI. Minor skin injury occurred in 14 (20%) patients; 4 (6%) were device-related. Skin injuries were associated with shock (P = 0.04), and decubitus ulcers were associated with left ventricular ejection fraction <45% (P = 0.004). AEs included shivering (94%), hypokalemia (81%), hyperglycemia (57%), pneumonia (23%), bleeding (22%), post-cooling fever (17%), and bacteremia (9%).

Conclusions

The Arctic Sun Temperature Management System was an effective means of performing therapeutic hypothermia after cardiac arrest. Infrequent skin injuries were associated with vasopressor use and low ejection fraction.

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Acknowledgments

The authors wish to acknowledge the outstanding contributions of research coordinators Tracy Robbins and Laurel Libby to this study.

Conflict of interest

The authors of this study report no financial conflict of interest with any commercial interest related to therapeutic hypothermia.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME, USA

    Salam Jarrah, John Dziodzio, Gilles L. Fraser, Richard R. Riker & David B. Seder

  2. Department of Nursing, Maine Medical Center, Portland, ME, USA

    Christine Lord

  3. Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA

    Lee Lucas

  4. Neuroscience Institute, Maine Medical Center, Portland, ME, USA

    Richard R. Riker & David B. Seder

  5. Tufts University School of Medicine, Medical Director of Neurocritical Care, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA

    David B. Seder

Authors
  1. Salam Jarrah
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  2. John Dziodzio
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  3. Christine Lord
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  4. Gilles L. Fraser
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  5. Lee Lucas
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  6. Richard R. Riker
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  7. David B. Seder
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Correspondence to David B. Seder.

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Jarrah, S., Dziodzio, J., Lord, C. et al. Surface Cooling after Cardiac Arrest: Effectiveness, Skin Safety, and Adverse Events in Routine Clinical Practice. Neurocrit Care 14, 382–388 (2011). https://doi.org/10.1007/s12028-011-9506-y

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  • DOI: https://doi.org/10.1007/s12028-011-9506-y

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