The Effects Of Ischemia

991 WordsSep 1, 20174 Pages
The incidence of sudden cardiac arrest (SCA) in the United States is estimated to be approximately 450,000.1 When occurring out-of-hospital, the majority of these cases are fatal.2 If return of spontaneous circulation (ROSC) is attained, only 8.3% of all patients who experience SCA have a favorable neurologic outcome.2 It has been shown that without perfusion to the brain for five minutes, ischemia produces the release of inflammatory mediators that ultimately result in cerebral injury.3 Almost three decades ago, evidence to support a potential treatment for this brain injury emerged. It was demonstrated in animal studies that moderate (34°C) or mild (36°C) hypothermia improved neurologic outcomes.4 The mechanism for this effect is…show more content…
13 As a consequence of the conflicting evidence, providers frequently choose a temperature goal on a per-patient basis. There are various clinical situations in which a certain goal might be preferable, however high-quality evidence is lacking. It has been suggested that the lower goal of 33°C may be advantageous in settings of complete loss of motor response, resulting in a deep coma, or if cerebral edema is detected. Other suggestions on the higher goal of 36°C exist for patients with partial motor response or patients at a high risk for bleed. The decision to utilize a goal of 36°C may be less common after a recent study found that this resulted in less time at the goal temperature (87% in 33°C cohort versus 50% in 36°C cohort), and more frequent fevers (0% in 33°C cohort versus 19% in 36°C cohort).14 The 36°C cohort was also less likely to receive
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