Hipotermia en RCP

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Es una presentación en las Jornadas de Terapia Intensiva en Cochabamba - Bolivia.

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  • Hipotermia en RCP

    1. 1. Dr. Roberto E. Gutiérrez Dorado Medicina Crítica y Terapia Intensiva La hipotermia en el Síndrome Posparada cardíaca Cochabamba - Bolivia 2011
    2. 3. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63– 81.
    3. 4. Nolan JP, et al. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee. Resuscitation. 2008;79:350–79.
    4. 5. D.F. Gaieski et al. Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest . Resuscitation 80 (2009) 418–424
    5. 7. S. Fukuda, D. S. Warner . Cerebral protection . Br J Anaesth 2007; 99: 10–17
    6. 8. 60 - 50 - 40 - 30 - 20 - 10 - 0 - 39 % 55 % The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. NEJM 2002;346:549-556 60 - 50 - 40 - 30 - 20 - 10 - 0 - Bernard, S.A. et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. NEJM 2002;346:557-563 Normotermia Hipotermia 26 % 49 % Normotermia Hipotermia P = 0,046 P = 0,009
    7. 9. Hiroyuki Yokoyama y et al. Impact of Therapeutic Hypothermia in the Treatment of Patients With Out-of-Hospital Cardiac Arrest From the J-PULSE-HYPO Study Registry . Circ J 2011; 75: 1063 – 1070
    8. 10. Fernando Pavel González-Ibarra, Joseph Varon, Elmer G. López-Meza , Therapeutic hypothermia: critical review of the molecular mechanisms of action; Frontiers in Neurology, February 2011, Volume 2, Article 4 .
    9. 11. Fernando Pavel González-Ibarra, Joseph Varon, Elmer G. López-Meza , Therapeutic hypothermia: critical review of the molecular mechanisms of action; Frontiers in Neurology, February 2011, Volume 2, Article 4 .
    10. 12. Fernando Pavel González-Ibarra, Joseph Varon, Elmer G. López-Meza , Therapeutic hypothermia: critical review of the molecular mechanisms of action; Frontiers in Neurology, February 2011, Volume 2, Article 4.
    11. 14. ¿Cuando? ¿Durante cuánto tiempo? ¿Hasta qué temperatura? y ¿A qué velocidad? ¿Cómo monitorizar la temperatura?
    12. 15. La administración de cristaloides 30–40 ml/kg e nfriados a 4 ºC. (SFL 0,9% o solución RL). + Bolsas de hielo. Técnicas de superficie. Técnicas endovasculares. Se recomienda a 0,25 – 0,5 ºC por hora.
    13. 16. Michael Holzer, M.D. Targeted Temperature Management for Comatose Survivors of Cardiac Arrest . N Engl J Med 2010;363:1256-64 .
    14. 17. Sistema intravascular Coolgard Alsius®
    15. 18. Anna Finley Caulfield, et al, Comparison of Cooling Techniques to Treat Cardiac Arrest Patients with Hypothermia . Stroke Research and Treatment Volume 2011, Article ID 690506, 6 pages doi:10.4061/2011/690506
    16. 19. Andreas Schneider, Bernd W. Böttiger, Erik Popp. Cerebral Resuscitation After Cardiocirculatory Arrest . Anesth Analg 2009;108:971–9
    17. 20. Muerte neuronal retardada, después de la isquemia cerebral global Neuronas piramidales del hipocampo (Ratas) después de 10 minutos de isquemia cerebro transitoria. HIP CA1 24 Horas 36 Horas 48 Horas CA1 CA3 DG
    18. 21. 10 min. 1 h. 6 h. HT local cabeza. HT Sistémica. Emanuela Keller, Regina Mudra, Christoph Gugl, Martin Seule, Susanne Mink, Juerg Fröhlich. Theoretical evaluations of therapeutic systemic and local cerebral hypothermia . Journal of Neuroscience Methods Volume 178, April 2009, 345-349 HT local cuello.
    19. 22. Wolfgang Weihs, Alexandra Schratter, Fritz Sterz,∗, Andreas Janata, Sandra Högler, Michael Holzer, Udo M. Losert, Harald Herkner, Wilhelm Behringer. The importance of surface area for the cooling efficacy of mild therapeutic hypothermia . Resuscitation 82 (2011) 74–78
    20. 23. Maaret Castrén. Intra-Arrest Transnasal Evaporative Cooling A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness) . Circulation. 2010;122:729-736.
    21. 24. Matthias Götberg. A Pilot Study of Rapid Cooling by Cold Saline and Endovascular Cooling Before Reperfusion in Patients With ST-Elevation Myocardial Infarction . Circ Cardiovasc Interv. 2010;3:400-407.
    22. 25. L.M. Batista et al. Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest . Resuscitation 81 (2010) 398–403
    23. 26. Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: A focus of hypothermia mediated alterations on the cytochrome P450 enzyme system. Crit Care Med. 2007;35:2196–204.
    24. 27. Michael Holzer, M.D. Targeted Temperature Management for Comatose Survivors of Cardiac Arrest . N Engl J Med 2010;363:1256-64.
    25. 28. Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: A focus of hypothermia mediated alterations on the cytochrome P450 enzyme system. Crit Care Med. 2007;35:2196–204.
    26. 29. Dion Stub, Stephen Bernard, Stephen J. Duffy and David M. Kaye. Post Cardiac Arrest Syndrome: A Review of Therapeutic Strategies . Circulation 2011;123;1428-1435 .
    27. 30. Gracias…

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