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You may be on a ventilator to help with breathing. You may have various lines and tubes to support body functions. People don't always respond right away to the procedure. It may take a couple of days. Providers often wait at least 3 days after the procedure to see how the cardiac arrest affected the brain. The procedure doesn't guarantee that you'll regain brain function.
Tests for brain function may be done to see how your brain has recovered. Some people do eventually wake up after therapeutic hypothermia. They may not have any lasting brain injury.
Others might have some problems with thinking. They'll need therapy. Sometimes cardiac arrest may harm other organs, like the kidneys. You'll need follow-up care. Medical care will depend on the reason for the cardiac arrest and the degree of damage. Other health problems you have will also determine the care you need.
You may need medicine, procedures, and physical therapy. Some people might need surgery for heart disease. Other people might need an automatic defibrillator. Almost everyone will need to stay in the hospital for a while. Other health problems you have will also determine the care you need. You may need medicine, procedures, and physical therapy. Some people might need surgery for heart disease. Other people might need an automatic defibrillator. Almost everyone will need to stay in the hospital for a while.
Talk with the healthcare provider about what to expect after the procedure. Health Home Treatments, Tests and Therapies. Why might I need therapeutic hypothermia after cardiac arrest? What are the risks of therapeutic hypothermia after cardiac arrest? Some of these risks include: Another abnormal heart rhythm, especially slow heart rates Severe blood infection sepsis Blood is less able to clot.
This can cause bleeding. Electrolyte and metabolic problems Raised blood sugar levels These risks may vary based on your age and other health problems. Ask your healthcare provider about the risks specific to you.
How do I get ready for therapeutic hypothermia after cardiac arrest? What happens during therapeutic hypothermia after cardiac arrest? Different medical centers may use different methods to do therapeutic hypothermia. In general: The medical team may start the hypothermia within 4 to 6 hours after the cardiac arrest. A healthcare provider will give you medicine to help you relax sedative. It makes you sleep and keeps you from shivering. You will not remember anything about the procedure afterward.
Although the trial is pragmatic, they did standardized treatment of several variables, including sedation and paralysis. The primary outcome was survival with a favourable neurologic outcome at 90 days defined as a Cerebral Performance Category CPC of 1 or 2. They enrolled patients, of which are included in the final analysis. They screened patients who met the inclusion criteria to find those The primary outcome, survival with good neurologic outcome, occurred in Before this trial was published, I was unsure about the utility of hypothermia.
Were the previous positive results real? Is fever avoidance the only important intervention? This trial tells us that the rhythm shockable versus non-shockable is probably irrelevant, but still leaves us with a lot of questions. Like many trials, they had to screen many more patients than were actually included in the trial, which results in potential selection bias. However, allocation concealment was appropriate in this trial, so the selection bias is more a concern for the generalizability of these results, rather than producing a systemic imbalance between the two groups.
The inclusion of in-hospital cardiac arrest patients also affects generalizability to emergency department patients. Although the results are statistically significant, they may not be replicable. The p value for the primary outcome was just barely below our standard cut off of 0. A single patient with a different outcome would have made the results of the trial statistically insignificant. That is especially important considering that the neurologic outcomes were based on phone interviews and the patients and their family members were not blinded to their treatment group.
As was discussed in the review of thrombolytics for stroke , cerebral performance scores are not reliably reproduced when repeated by different interviewers. This introduces significant potential for bias and makes the results less reliable.
The decision to withdraw care can have a major impact in any cardiac arrest trial. If physicians are too pessimistic, we may withdraw care before any benefit from treatment can be seen. In the TTM trial, they blinded the doctor performing neuroprognostication, which should help. For example, after noticing that they patient did not receive hypothermia, the physician might lower their prognosis, increasing the chance of withdrawal of life support.
Life support withdrawal was a slightly more common cause of death in the normothermia group Given the limitations, it is hard to know for sure. I am slightly less skeptical of hypothermia overall than I was before the trial was published.
The HYPERION trial adds to the evidence that strict temperature control and possibly mild hyperthermia results in better outcomes for comatose cardiac arrest patients. It is the first trial to focus specifically on patients with non-shockable rhythms. A massive thank you to our supporters for helping to keep First10EM running.
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