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Latest & greatest articles for hypothermia
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Therapeutic hypothermia after out-of-hospital cardiac arrest in children. Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than (...) 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac
Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study. To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation.Nationwide retrospective cohort study.Emergency departments and paediatric intensive care units of the eight (...) university medical centres in the Netherlands.Children aged up to 16 with cardiac arrest and hypothermia after drowning, who presented at emergency departments and/or were admitted to intensive care.Survival and neurological outcome one year after the drowning incident. Poor outcome was defined as death or survival in a vegetative state or with severe neurological disability (paediatric cerebral performance category (PCPC) ≥ 4).From 1993 to 2012, 160 children presented with cardiac arrest and hypothermia
Thermogard XP for therapeutic hypothermia after cardiac arrest Thermogard XP for ther Thermogard XP for therapeutic h apeutic hypothermia ypothermia after cardiac arrest after cardiac arrest Medtech innovation briefing Published: 9 September 2015 nice.org.uk/guidance/mib37 pathways Summary Summary The Thermogard XP temperature management system controls a patient's body temperature through central venous heat exchange. It can be used to induce and maintain therapeutic hypothermia in critically (...) to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1 of 44Product summary and lik Product summary and likely place in ther ely place in therap apy y Thermogard XP controls a patient's body temperature through central venous heat exchange. It can be used for both cooling and warming clinical applications. This briefing focuses on its use for initiating and maintaining therapeutic hypothermia in critically ill adult patients after cardiac arrest. Thermogard XP would
Moderate hypothermia within 6 h of birth plus inhaled xenon versus moderate hypothermia alone after birth asphyxia (TOBY-Xe): a proof-of-concept, open-label, randomised controlled trial Moderate cooling after birth asphyxia is associated with substantial reductions in death and disability, but additional therapies might provide further benefit. We assessed whether the addition of xenon gas, a promising novel therapy, after the initiation of hypothermia for birth asphyxia would result in further (...) improvement.Total Body hypothermia plus Xenon (TOBY-Xe) was a proof-of-concept, randomised, open-label, parallel-group trial done at four intensive-care neonatal units in the UK. Eligible infants were 36-43 weeks of gestational age, had signs of moderate to severe encephalopathy and moderately or severely abnormal background activity for at least 30 min or seizures as shown by amplitude-integrated EEG (aEEG), and had one of the following: Apgar score of 5 or less 10 min after birth, continued need
Does Initiation of Therapeutic Hypothermia in the Out-of-Hospital Environment Improve Neurologic Outcomes? Systematic Review Snapshot TAKE-HOME MESSAGE In cardiac arrest, the initiation of therapeutic hypothermia in the out-of-hospital environment has not been shown to improve neurologic outcomes, although studies to date have been limited. Does Initiation of Therapeutic Hypothermia in the Out-of-Hospital Environment Improve Neurologic Outcomes? EBEM Commentators Joshua Bucher, MD Rutgers (...) Category of 0 to 2, modi?ed Ran- kin score of 0 to 2, or overall performance category of 0 to 2. Pooled results for out-of-hospital therapeutic hypothermia versus standard care. Outcome RR 95% CI Number of Studies (Number of Patients) VF survival 1.05 0.77–1.44 3 (553) Non-VF survival 0.95 0.64–3.91 3 (482) VF with good neurologic outcome 1.00 0.65–1.52 3 (428) Non-VF with good neurologic outcome 1.31 0.59–2.88 2 (357) VF, Ventricular ?brillation. METHODS DATA SOURCES Multiple sources were searched
Normothermia versus Therapeutic Hypothermia for Adult Patients after Cardiac Arrest TITLE: Normothermia versus Therapeutic Hypothermia for Adult Patients after Cardiac Arrest: Clinical Evidence DATE: 26 August 2014 RESEARCH QUESTION What is the clinical evidence for neurological benefits or harms of maintaining normothermia versus induction of therapeutic hypothermia in adult patients following cardiac arrest? KEY FINDINGS Six systematic reviews and one randomized controlled trial were (...) identified regarding the comparative neurological benefits and harms of maintaining normothermia versus induction of therapeutic hypothermia in adult patients following cardiac arrest. METHODS A limited literature search was conducted on key resources including PubMed, The Cochrane Library (2014, Issue 8), University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused Internet search. Methodological filters were
Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy: An Updated Systematic Review and Meta-analysis PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Hypothermia and Early Neonatal Mortality in Preterm Infants To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants.This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed (...) neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression.Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables
Safety and efficacy of therapeutic hypothermia for acute ischemic stroke. Systematic review and Meta-analysis Seguridad y eficacia de la terapia hipotérmica en el ictus isquémico agudo. Revisión sistemática y metaanálisis [Safety and efficacy of therapeutic hypothermia for acute ischemic stroke. Systematic review and Meta-analysis] Seguridad y eficacia de la terapia hipotérmica en el ictus isquémico agudo. Revisión sistemática y metaanálisis [Safety and efficacy of therapeutic hypothermia (...) of therapeutic hypothermia for acute ischemic stroke. Systematic review and Meta-analysis] Seville: Andalusian Agency for Health Technology Assessment (AETSA). AETSA 2013/5-2. 2013 Authors' conclusions Therapeutic Hypothermia can be achieved by different devices. Methods involve surface cooling (noninvasive), and internal cooling (non-invasive and invasive). According to the type of methods used, the therapeutic hypothermia presents different complexity and risks for patients. The neuroprotective effect
Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. Hospital cooling improves outcome after cardiac arrest, but prehospital cooling immediately after return of spontaneous circulation may result in better outcomes.To determine whether prehospital cooling improves outcomes after resuscitation from cardiac arrest in patients with ventricular fibrillation (VF) and without VF.A randomized clinical
Effects of hypothermia for perinatal asphyxia on childhood outcomes. In the Total Body Hypothermia for Neonatal Encephalopathy Trial (TOBY), newborns with asphyxial encephalopathy who received hypothermic therapy had improved neurologic outcomes at 18 months of age, but it is uncertain whether such therapy results in longer-term neurocognitive benefits.We randomly assigned 325 newborns with asphyxial encephalopathy who were born at a gestational age of 36 weeks or more to receive standard care (...) alone (control) or standard care with hypothermia to a rectal temperature of 33 to 34°C for 72 hours within 6 hours after birth. We evaluated the neurocognitive function of these children at 6 to 7 years of age. The primary outcome of this analysis was the frequency of survival with an IQ score of 85 or higher.A total of 75 of 145 children (52%) in the hypothermia group versus 52 of 132 (39%) in the control group survived with an IQ score of 85 or more (relative risk, 1.31; P=0.04). The proportions
Normothermia versus therapeutic hypothermia for adult patients after cardiac arrest: clinical evidence Normothermia versus therapeutic hypothermia for adult patients after cardiac arrest: clinical evidence Normothermia versus therapeutic hypothermia for adult patients after cardiac arrest: clinical evidence CADTH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made (...) for the HTA database. Citation CADTH. Normothermia versus therapeutic hypothermia for adult patients after cardiac arrest: clinical evidence. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response. 2014 Authors' conclusions Six systematic reviews and one randomized controlled trial were identified regarding the comparative neurological benefits and harms of maintaining normothermia versus induction of therapeutic hypothermia in adult patients following cardiac arrest. Final
Paediatric Traumatic Brain Injury Consortium. Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Induced Hypothermia in Severe Bacterial Meningitis: A Randomized Clinical Trial. Despite advances in care, mortality and morbidity remain high in adults with acute bacterial meningitis, particularly when due to Streptococcus pneumoniae. Induced hypothermia is beneficial in other conditions with global cerebral hypoxia.To test the hypothesis that induced hypothermia improves outcome in patients with severe bacterial meningitis.An open-label, multicenter, randomized clinical trial in 49 intensive (...) [favorable outcome] vs a score of 1-4 [unfavorable outcome]). All patients received appropriate antimicrobial therapy and vital support. Analyses were performed on an intention-to-treat basis. The data and safety monitoring board (DSMB) reviewed severe adverse events and mortality rate every 50 enrolled patients.After inclusion of 98 comatose patients, the trial was stopped early at the request of the DSMB because of concerns over excess mortality in the hypothermia group (25 of 49 patients [51%]) vs
Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial On the basis of mixed results from previous trials, we assessed whether therapeutic hypothermia for 48-72 h with slow rewarming improved mortality in children after brain injury.In this phase 3, multicenter, multinational, randomised controlled trial, we included patients with severe traumatic brain injury who were younger than 18 years and could (...) be enrolled within 6 h of injury. We used a computer-generated randomisation sequence to randomly allocate patients (1:1; stratified by site and age [<6 years, 6-15 years, 16-17 years]) to either hypothermia (rapidly cooled to 32-33°C for 48-72 h, then rewarmed by 0·5-1·0°C every 12-24 h) or normothermia (maintained at 36·5-37·5°C). The primary outcome was mortality at 3 months, assessed by intention-to-treat analysis; secondary outcomes were global function at 3 months after injury using the Glasgow
Therapeutic hypothermia for cardiac arrest of asphyxial origin BestBets: Therapeutic hypothermia for cardiac arrest of asphyxial origin Therapeutic hypothermia for cardiac arrest of asphyxial origin Report By: Eric Mercier - Emergency medicine PGY-3 Search checked by Gareth Roberts - Central Manchester University Hospitals NHS Foundation Trust, UK Institution: Laval University, Quebec, Canada Date Submitted: 17th July 2012 Date Completed: 25th July 2013 Last Modified: 25th July 2013 Status (...) : Green (complete) Three Part Question In [comatose adults patients presenting to the emergency department following asphyxia] does [therapeutic hypothermia] improve [neurologic outcome]? Clinical Scenario A 34-year-old woman is discovered hanging from a noose around her neck. When a family member discovers her, she is in respiratory arrest and comatose. The paramedics provide artificial ventilation. After several minutes, the patient\'s breathing returns but she remains unconscious. On arrival