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Áhrif kælingar á einkenni frá heila eftir hjartastopp

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Authors
Steinar Björnsson
Felix Valsson
Issue Date
2004-09-01

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Induced hypothermia after cardiac arrest in Iceland
Citation
Læknablaðið 2004, 90(9):609-613
Abstract
Objective: The number of out-of-hospital cardiac arrests in Iceland is about 200/year. In 2002, two prospective randomized trails showed improved outcome when mild hypothermia was induced in a very selective group of comatose patients after cardiac arrest. At Landspitali University Hospital at Hringbraut, hypothermic treatment after a cardiac arrest has been used since Mars 2002. Aim of this study was to: 1) Evaluate outcome of all comatose patients after cardiac arrest in two time periods before and after induced-hypothermia was implemented at our hospital. 2) Estimate how fast and well the patients were cooled with external cooling. Material and methods: 20 patients received hypothermic treatment after resuscitation during the period from mars until December 2002. These patients were compared with 32 other patients who did not receive hypothermic treatment after resuscitation from a cardiac arrest, during the period from January 2000 until March 2002. Information regarding, time from the arrest to beginning of resuscitation (t-1), time from the arrest to return of spontaneous circulation (t-2), time from the arrest until the cooling was actively started (t-3), time from the arrest until the lowest temperature was achieved (t-4), and how many got to the target temperature (32-34°C), where gathered from medical journals. The primary outcome measure was survival to hospital discharge with sufficientlygoodneurologicfunctiontobedischargedtohome or to a rehabilitation facility. Results: 40% of the hypothermic had a good neurologic outcome compared with 28% of the normothermic group. T-1 was 3,2 min. and 3,3 min., t-2 was 35,4 min. and 29,3 min. on average in the hypothermic group and the normothermic group, respectively. T-3 was 2,8 hours and t-4 was 9,8 hours on average in the hypothermic group. 40% of the hypothermic group did not reach target temperature. Conclusion: The results of this study show that 40% of the patients where hypothermia was induced had good neurological outcome compared with 28% of the patients where hypothermia was not induced. In contrast to other studies, the present study included all comatous patients arriving to the hospital after cardiac arrest, regardless of the type of arrythmia and the time from the arrest to return of spontaneus circulation. This study also shows that the cooling technique used is slow and insufficientinachievingthetargettemperature set in this study.
Tilgangur: Hjartastopp utan spítala á Íslandi eru um það bil 200/ári. Nýlegar klínískar ranns­­óknir benda til þess að kæling eftir hjartastopp sé taugaverndandi. Á Landspítala við Hringbraut hefur kælingu verið beitt sem meðferð eftir hjartastopp síðan í mars 2002. Til­­gangur þessarar rannsóknar var að: 1) meta áhrif kælingar á afdrif sjúklinga með og án kælingar. 2) meta árangur þess hversu hratt og vel tókst að kæla sjúklingana. Efniviður og aðferðir: Alls voru 20 sjúklingar kældir á tímabilinu mars til desember 2002. Þessir sjúklingar voru bornir saman við 32 sjúklinga sem ekki voru kældir sem lögðust inn eftir hjartastopp á tímabilinu janúar 2000 til mars 2002. Upplýsingar voru fengnar úr sjúkraskrám varðandi; tíma frá áfalli að endur­lífgun (t-1), tíma frá áfalli þar til sjálfvirkt blóðflæði komst á (t-2), tíma frá áfalli þar til kæling er hafin (t-3), tíma frá áfalli þar til lægsta hitastig náðist (t-4) og hversu margir náðu kjörhitastigi (32-34° C). Afdrif sjúklinganna voru metin eftir því hvert þeir út­skrif­uðust. Útkoma var talin góð ef sjúklingur útskrifaðist heim eða á endurhæfingardeild, slæm ef sjúklingur útskrifaðist á langlegudeild eða lést. Niðurstöður: Góð útkoma var skráð hjá 40% kældra saman­borið við 28% ekki kældra. T-1 var 3,2 mínútur og 3,3 mínútur, t-2 var 35,4 mínútur og 29,3 mínútur að meðal­tali hjá kæld­um og ekki kældum, í þessari röð. T-3 var 2,8 klukkustundir og t-4 var 9,8 klukku­stundir að meðal­tali hjá kælda hópnum. 40% sjúklinganna í kælda hópnum fóru ekki undir 34° C. Umræður: Niðurstöður þessarar rannsóknar sýndu að 40% sjúklinga sem voru kældir fengu góðan bata eftir hjartastopp miðað við góðan bata hjá 28% sjúklinga sem ekki voru kældir. Gagnstætt öðrum rannsóknum náði þessi rannsókn til allra sem komu meðvitundarlausir inn á sjúkrahús eftir hjartastopp, óháð tegund hjartsláttaróreglu eða tímalengd frá áfalli. Einnig sýndi rannsóknin að með ytri kælingu gekk illa og hægt að ná því hitastigi sem stefnt var að.
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