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Milde therapeutische Hypothermie im kardiogenen Schock

Retrospektive Analyse von 80 Patienten mit präklinischem Herz-Kreislauf-Stillstand kardialer Ursache

Mild therapeutic hypothermia in cardiogenic shock

Retrospective analysis of 80 patients with preclinical cardiac arrest due to cardiac causes

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Zusammenfassung

Hintergrund

Die Sterblichkeit bei Patienten mit kardiogenem Schock nach Herzstillstand bleibt trotz der Fortschritte bei den Wiederbelebungsmaßnahmen und der frühen Revaskularisierung sehr hoch. Gegenwärtig wird der Einsatz der milden therapeutischen Hypothermie (MTH) zur Verbesserung des Überlebens und neurologischen Outcomes bei diesem Patientenkollektiv neu diskutiert.

Fragestellung

Detektion von Einflussfaktoren auf Morbidität und Mortalität bei Patienten nach präklinischer Reanimation [„out-of-hospital cardiac arrest“ (OHCA)] unter MTH im kardiogenen Schock.

Methodik

Retrospektive Analyse von 80 konsekutiven Patienten (mittleres Alter 60 ± 3,2 Jahre) im kardiogenen Schock. Alle Patienten wurden mithilfe eines endovaskulären Kühlkatheters für 24 h gekühlt. Das neurologische Outcome der Patienten wurde 2 Monate nach OHCA basierend auf der Glasgow-Pittsburgh Cerebral Performance Category (CPC) erhoben und mit verschiedenen Blutwerten korreliert.

Ergebnisse

Zwei Monate nach Indexereignis zeigten 31 Patienten (39 %) eine gute neurologische Erholung (CPC 1–2), 20 Patienten (25 %) wiesen ein schlechtes neurologisches Outcome (CPC 3–4) auf. 29 Patienten (36 %) waren verstorben (CPC 5). Bei den Patienten mit schlechtem neurologischem Outcome fanden sich signifikant höhere Laktat-, Kreatinin- und Harnstoffwerte. Zudem kam es bei diesen Patienten, im Gegensatz zu den Patienten mit gutem neurologischem Outcome, zu einem kontinuierlichen Anstieg der neuronenspezifischen Enolase (NSE; ∆ NSE, Ankunft zu Tag 1, CPC 1–2: − 10,6 ± 3 µg/l; CPC 3–5: 33 ± 12 µg/l; p = 0,02).

Schlussfolgerung

Der Verlauf von Kreatinin, Harnstoff und NSE im Serum innerhalb der ersten 72 h nach OHCA könnte bei Patienten unter MTH wertvolle ergänzende Informationen zur frühzeitigen Beurteilung der neurologischen Prognose bieten.

Abstract

Background

The mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation and early revascularization strategies. The use of mild therapeutic hypothermia (MTH) for improvement of survival and neurological outcome in patients with cardiogenic shock is currently subject to renewed discussion.

Objective

The aim of this study was the detection of risk factors for mortality and morbidity in patients under MTH in cardiogenic shock following preclinical resuscitation for OHCA.

Methods

A total of 80 consecutive patients in cardiogenic shock after successful resuscitation (mean age 60 ± 3.2 years) treated with MTH were retrospectively analyzed. Patients were cooled to 33 °C for 24 h using an endovascular cooling device. Neurological outcome was assessed after 2 months based on the Glasgow-Pittsburgh cerebral performance category (CPC) and correlated with various blood parameter values.

Results

After 2 months 31 patients (39 %) showed a good neurological recovery with CPC scores of 1–2, 20 patients (25 %) had a poor neurological outcome with CPC scores of 3–4 and 29 (36 %) patients enrolled in the trial died (CPC 5). Patients with a poor outcome showed significantly higher mean serum levels for lactate, creatinine and urea. In addition, these patients showed a continuous increase of serum neuron-specific enolase (NSE) values in contrast to patients with a good outcome (∆ NSE from admission to day 1, CPC 1 and 2: − 10.6 ± 3 µg/l and CPC 3–5: 33 ± 12 µg/l, p = 0.02).

Conclusion

Changes in the course of serum creatinine, urea and NSE levels within the first 72 h after OHCA could provide valuable additional information for the early assessment of the neurological prognosis in patients treated with MTH.

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Correspondence to H. Reuter.

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Interessenkonflikt

C. Adler, R. Pfister, S. Baldus und H. Reuter geben an, dass kein Interessenkonflikt besteht.

Die Datenerhebung wurde mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Adler, C., Pfister, R., Baldus, S. et al. Milde therapeutische Hypothermie im kardiogenen Schock. Med Klin Intensivmed Notfmed 112, 24–29 (2017). https://doi.org/10.1007/s00063-015-0122-z

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  • DOI: https://doi.org/10.1007/s00063-015-0122-z

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