Victims Of Sudden Cardiac Arrest Can Often Be Saved By Therapeutic Hypothermia – Part 2 of 3
But things were different at the seven-day mark: At that point, 33 percent of hypothermia-treated patients were alert and had only mild deficits. And by the time of their hospital discharge, 83 percent of the hypothermia-treated patients were signal and had only mild deficits, the researchers found. “Our data are preliminary, provocative but not robust enough to prompt change in clinical practice,” Eid stated.
In the more recent study, a team led by Dr Kyle McCarty, an emergency medicine resident at Maricopa Medical Center in Phoenix, found that withdrawing hypothermia before three days was common even though it was counter to existing protocols. “Thus far we have found that in defiance of the fact that current guidelines state that the neurological prognosis after cardiac arrest cannot be reliably assessed within 72 hours of the completion of therapeutic hypothermia, the timing of withdrawal of protection after hypothermia is highly variable”. In fact, “early withdrawal of care is common even in a system with specific protocols aimed at preventing early withdrawal”.
Of the 177 patients studied, hypothermia tribulation was withdrawn from one-third of patients within 24 hours and close to one-third (30 percent) of patients within 25 to 72 hours. Only about one-quarter of the patients studied received medical hypothermia for the recommended minimum of 72 hours, McCarty’s team found. “This study implies that even in a system with specific protocols set up to prevent early withdrawal of care in patients who have undergone health-giving hypothermia, there is significant variability in the timing of care withdrawal, frequently prior to the recommended 72 hours”.
And in the final study, Dr Keith Lurie, a professor of medicine at the University of Minnesota in Minneapolis, and colleagues found that withdrawing spark of life support 72 hours after re-warming “may prematurely terminate life in at least 10 percent of all potentially neurologically intact survivors” of cardiac stop treated with hypothermia. For the study, Lurie’s team looked at the time from when patients had been fully “re-warmed” to when they showed signs of awakening – including being alert and oriented.
Among the 66 patients studied, six who showed signs of brains re-awakening beyond the traditional 72-hour cut-off regained good neurological function within a month of the cardiac arrest. However, comatose patients were most of the time treated after hypothermia for at least two days before any decision to withdraw care was made, the researchers noted.
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