12. Therapeutic hypothermia in PEA cardiac arrest for global and local cerebral protection: a case report and mini-review

C. Smith, A. Coleman, Y. Al-Baghdadi, M. Orlewicz

Department of Anesthesiology Wayne State/Detroit Medical Center, Harper Hospital, Detroit, Michigan 48201

Abstract

Therapeutic hypothermia (TH) has received increased attention in the last decade, although this treatment modality has been around since the 1940’s. TH is used as an adjuvant therapy for patients with refractory arrhythmias, cardiac arrest and traumatic brain injuries. We discuss the use of TH for CNS protection following pulseless electrical activity (PEA) cardiac arrest secondary to hypoxemia for a patient who had recently undergone three-vessel coronary bypass graft (CABG) surgery. The patient remained unresponsive after successful resuscitation and a head CT exhibited a new, acute left cerebral infarct. Initiation of TH was undertaken for both global protection and to minimize reperfusion injury to the new, local left infarct. Six hours after cardiac arrest the body temperature was lowered to 33° C for 24 hours and then the patient was re-warmed over the next 12 hours back to 36-37° C. Return of baseline mental status and continued improvement of hemiparesis was observed at the 36th hour. This case demonstrates the utility of TH to protect the brain both globally and locally after a PEA cardiac arrest in a patient that has undergone major cardiovascular surgery.

Keywords: therapeutic hypothermia, coronary artery bypass graft, pulseless electrical activity, ventilator associated pneumonia, cerebral protection

J Rom Anest Terap Int 2011; 18: 153-155

Hipotermia terapeutică în stopul cardiac prin asistolie pentru protecţia cerebrală globală şi locală: prezentare de caz şi mini-review