La hipotermia en el La hipotermia en el Síndrome Posparada cardíaca Síndrome Posparada cardíaca

Dr. Roberto E. Gutiérrez DoradoDr. Roberto E. Gutiérrez DoradoMedicina Crítica y Terapia IntensivaMedicina Crítica y Terapia Intensiva

Cochabamba - BoliviaCochabamba - Bolivia20112011

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.

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.

D.F. Gaieski et al. Early goal-directed hemodynamic optimization combined with therapeutichypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation 80 (2009) 418–424

S. Fukuda, D. S. Warner. Cerebral protection. Br J Anaesth 2007; 99: 10–17

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

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

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.

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.

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.

¿Cuando?

¿Durante cuánto tiempo?

¿Hasta qué temperatura? y ¿A qué velocidad?

¿Cómo monitorizar la temperatura?

La administración de cristaloides 30–40 ml/kg enfriados 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.

Michael Holzer, M.D. Targeted Temperature Management for Comatose Survivors of Cardiac Arrest. N Engl J Med 2010;363:1256-64.

Sistema intravascular Coolgard Alsius®

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

Andreas Schneider, Bernd W. Böttiger, Erik Popp. Cerebral Resuscitation After Cardiocirculatory Arrest. Anesth Analg 2009;108:971–9

Muerte neuronal retardada, después de la isquemia cerebral global

Neuronas piramidales del hipocampo (Ratas) después de10 minutos de isquemia cerebro transitoria.

HIP

CA1

24 Horas 36 Horas 48 Horas

CA1

CA3DG

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.

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

Maaret Castrén. Intra-Arrest Transnasal Evaporative Cooling A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation. 2010;122:729-736.

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.

L.M. Batista et al. Feasibility and safety of combined percutaneous coronary intervention andtherapeutic hypothermia following cardiac arrest. Resuscitation 81 (2010) 398–403

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.

Michael Holzer, M.D. Targeted Temperature Managementfor Comatose Survivors of Cardiac Arrest. N Engl J Med 2010;363:1256-64.

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.

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.

Gracias…Gracias…