Infectious complications in patients after cardiac arrest undergoing therapeutic hypothermia

Česká verzia

Authors: R. Sýkora
Authors place of work: Anesteziologicko-resuscitační oddělení nemocnice v Karlových Varech, Karlovarská krajská nemocnice, a. s., Karlovy Vary, přednosta prim. MUDr. Roman Brázdil
Published in the journal: Vnitř Lék 2011; 57(5): 491-495
Category: Reviews

Summary

Therapeutic hypothermia is currently recommended neuroprotective therapeutic measure for comatose patients after cardiac arrest. Hypothermia has been proven not only to affect the neurological outcomes but also the survival of patients after cardiac arrest. This communication summarizes the issue of early infectious complications in patients after cardiac arrest undergoing therapeutic hypothermia. Diagnosis of infectious events is complicated in patients after cardiac arrest not only by the physiological effects of therapeutic hypothermia but also by the consequences of reperfusion injury and development of postresuscitation disease associated with systemic inflammatory response syndrome. Furthermore, there are discussed limited diagnostic options of infectious complications. The significance of the usual symptoms of infections is reduced, as well as the value of laboratory markers such as procalcitonin and C-reactive protein. Finally, the possibility of antibiotic treatment and eventual antibiotic prophylaxis during therapeutic hypothermia in patients after cardiac arrest outside hospitals is mentioned.

Key words:
therapeutic hypothermia – cardiac arrest – infectious complications – antibiotic treatment

Zdroje

1. Bernard SA, Gray TW, Buist MD et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346: 557–563.

2. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549–556.

3. Nolan JP, Morley PT, Hoek TL et al. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation 2003; 57: 231–235.

4. ECC Committee. Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112 (Suppl 24): IV1–IV203.

5. Škulec R, Truhlář A, Ošťádal P et al. Současné ochlazovací metody pro indukci mírné terapeutické hypotermie po srdeční zástavě. Vnitř Lék 2009; 55: 1060–1069.

6. Cvachovec K, Černý V, Dostál P et al. ČLS JEP: Konsenzuální stanovisko k použití terapeutické hypotermie. Anest Intenziv Med 2009; 20: 221–224.

7. Bernard S. Hypothermia after cardiac arrest: expanding the therapeutic scope. Crit Care Med 2009; 37 (Suppl 7): S227–S233.

8. Skulec R, Truhlar A, Knor J et al. Broad implementation of therapeutic hypothermia after cardiac arrest-Mission possible. Resuscitation 2010; 81: 779–780.

9. Polderman KH, Herold I. Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods. Crit Care Med 2009; 37: 1101–1120.

10. Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009; 37 (Suppl 7): S186–S202.

11. Sinclair HL, Andrews PJ. Bench-to-bedside review: Hypothermia in traumatic brain injury. Crit Care 2010; 14: 204.

12. Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet 2008; 371: 1955–1969.

13. Goto T, Hazui H, Hoshiga M et al. Bacterial translocation after mild therapeutic hypothermia. Resuscitation 2009; 80: 960.

14. Nolan JP, Neumar RW, Adrie C et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation 2008; 79: 350–379.

15. Binks A, Nolan JP. Post-cardiac arrest syndrome. Minerva Anestesiol 2010; 76: 362–368.

16. Trzeciak S, Jones AE, Kilgannon JH et al. Significance of arterial hypotension after resuscitation from cardiac arrest. Crit Care Med 2009; 37: 2895–2903.

17. Adrie C, Laurent I, Monchi M et al. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 2004; 10: 208–212.

18. Adrie C, Adib-Conquy M, Laurent I et al. Successful cardiopulmonary resuscitation after cardiac arrest as a „sepsis-like” syndrome. Circulation 2002; 106: 562–568.

19. Tsai MS, Chiang WC, Lee CC et al. Infections in the survivors of out-of-hospital cardiac arrest in the first 7 days. Intensive Care Med 2005; 31: 621–626.

20. Batista LM, Lima FO, Januzzi JL Jr et al. Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest. Resuscitation 2010; 81: 398–403.

21. Sagalyn E, Band RA, Gaieski DF et al. Therapeutic hypothermia after cardiac arrest in clinical practice: review and compilation of recent experiences. Crit Care Med 2009; 37 (Suppl 7): S223–S226.

22. Pichon N, Amiel JB, François B et al. Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system. Crit Care 2007; 11: R71.

23. Sýkora R, Janda R. Terapeutická hypotermie po srdeční zástavě na 12 hodin: Karlovy Vary 2006-2009. Vnitř Lék 2011; 57: 72–77.

24. Janda R, Sýkora R. Kardiogenní šok se systémovou zánětlivou odpovědí – komplikace akutního infarktu myokardu. Anest Intenziv Med 2010; 21: 14–17.

25. Škarvan K. Po stopách ztracené rezistence. Anest Intenziv Med 2010; 21: 3–5.

26. Christ-Crain M, Opal SM. Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia. Crit Care 2010; 14: 203.

27. Schuetz P, Albrich W, Christ-Crain M et al. Procalcitonin for guidance of antibiotic therapy. Expert Rev Anti Infect Ther 2010; 8: 575–587.

28. Fries M, Stoppe C, Brücken D et al. Influence of mild therapeutic hypothermia on the inflammatory response after successful resuscitation from cardiac arrest. J Crit Care 2009; 24: 453–457.

29. Schuetz P, Affolter B, Hunziker S et al. Serum procalcitonin, C-reactive protein and white blood cell levels following hypothermia after cardiac arrest: a retrospective cohort study. Eur J Clin Invest 2010; 40: 376–381.

30. Mongardon N, Lemiale V, Perbet S et al. Value of procalcitonin for diagnosis of early onset pneumonia in hypothermia-treated cardiac arrest patients. Intensive Care Med 2010; 36: 92–99.

31. Amour J, Birenbaum A, Langeron O et al. Influence of renal dysfunction on the accuracy of procalcitonin for the diagnosis of postoperative infection after vascular surgery. Crit Care Med 2008; 36: 1147–1154.

32. Kupchik NL. Development and implementation of a therapeutic hypothermia protocol. Crit Care Med 2009; 37 (Suppl 7): S279–S284.