Báo cáo y học: Number needed to treat = six: therapeutic hypothermia following cardiac arrest – an effective and cheap approach to save lives

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Number needed to treat = six: therapeutic hypothermia following cardiac arrest – an effective and cheap approach to save lives...
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Báo cáo y học: "Number needed to treat = six: therapeutic hypothermia following cardiac arrest – an effective and cheap approach to save lives" Available online http://ccforum.com/content/11/4/162CommentaryNumber needed to treat = six: therapeutic hypothermia followingcardiac arrest – an effective and cheap approach to save livesBernd W Böttiger, Andreas Schneider and Erik PoppDepartment of Anaesthesiology, University of Heidelberg, GermanyCorresponding author: Bernd W Böttiger, bernd.boettiger@med.uni-heidelberg.dePublished: 31 August 2007 Critical Care 2007, 11:162 (doi:10.1186/cc6100)This article is online at http://ccforum.com/content/11/4/162© 2007 BioMed Central LtdSee related research by Pichon et al., http://ccforum.com/content/11/3/R71Abstract 2. Induced hypothermia might also benefit unconscious adult patients with spontaneous circulation after out-of-In 2005, the European Resuscitation Council (ERC) guidelines hospital cardiac arrest from a non-shockable rhythm, orstated: Unconscious adult patients with spontaneous circulation cardiac arrest in hospital.after out-of-hospital ventricular fibrillation cardiac arrest should becooled to 32 to 34°C for 12 to 24 hours. Patients with cardiac 3. A child who regains a spontaneous circulation butarrest from a non-shockable rhythm, in-hospital patients and remains comatose after cardiopulmonary arrest maychildren may also benefit from hypothermia. There is no argument benefit from being cooled to a core temperature of 32 toto wait. We have to treat the next unconscious cardiac arrest 34°C for 12 to 24 hours.patient with hypothermia. Therapeutic hypothermia influences postresuscitation brain – and other organ – injury in many different ways: it reducesThe article “Efficacy of and tolerance to mild induced metabolism, free radical formation, intracellular calciumhypothermia after out-of-hospital cardiac arrest using an overload, as well as translation and transcription of patho-endovascular cooling system” by Pichon et al. in the previous genic proteins. Additionally, it has anti-apoptotic, anti-inflam-issue of Critical Care [1] points to a very relevant health care matory and anti-coagulatory properties and can reduceissue. Only 10% of patients undergoing out-of-hospital oedema formation [8].cardiopulmonary resuscitation are discharged alive from thehospital. This high mortality is to a major part due to There are few areas in emergency and intensive careischaemic brain damage. In 2002, a European multicentre medicine where scientific evidence is so strong and wheretrial on the use of mild therapeutic hypothermia – as well as international guidelines are so clear. Nevertheless,other clinical trials – clearly demonstrated a decrease in implementation of hypothermia is lousy. In most countries onmortality and a better neurological outcome in cardiac arrest both sides of the Atlantic, under 30% of cardiac arrestpatients [2,3]. Only six patients have to be treated to save patients are receiving hypothermia [9]. The reasons areone life (number needed to treat = six) [4]. This is far better multifactorial. Colleagues are stating that they do not havethan with most other – expensive – approaches in the enough information and experience, that this therapy is notintensive care unit (ICU) [5]. Consequently, therapeutic hypo- evidence-based and that it is technically too difficult. Mildthermia has been recommended in an Advisory Statement by therapeutic hypothermia is definitely underused post cardiacthe International Liaison Committee on Resuscitation arrest, and many patients who need not die are dying(ILCOR) already in 2003 [6]. In 2005, the European because of this clinical reality.Resuscitation Council (ERC) guidelines stated [7]:1. Unconscious adult patients with spontaneous circulation Here, it is very important that independent groups do support after out-of-hospital ventricular fibrillation cardiac arrest implementation of hypothermia. Pichon and colleagues report should be cooled to 32 to 34°C. Cooling should be on the efficacy and tolerance of a commercially available started as soon as possible and continued for at least 12 intravascular cooling device used in 40 post cardiac arrest to 24 hours. patients [1]. Cooling with this device was safe, relatively fastERC = European Resuscitation Council; ICU = intensive care unit; ILCOR = International Liaison Committee on Resuscitation. Page 1 of 2 ...