Therapeutic Hypothermia After Cardiac Arrest

R505 Advanced Research Methods

Author (year) Purpose Sample/Number of Participants (provide descriptive statistics) Design Level of Evidence Findings (provide any inferential statistics) Limitations
Cronberg, Horn, Kuiper, Friberg , & Nielsen, 2013 To describe and analyze the efficiency and applicability of cooling measures and therapeutic hypothermia (TH) in neurological assessment. 950 adult patients participated in the research. All of them experienced cardiac arrest in 2013. They were observed for 180 consecutive days. Prognostication/description of the negative outcomes in patients in the sampling group after they were exempted from life sustaining therapy (WLST). Evidence from descriptive studies. The withdrawal of cooling measures should be performed no earlier than 72 hours after rewarming resulting in a timeframe no less than 4.5 days after the arrest. No practical and ethical outcomes were evaluated or discussed.
Deye, Arrich, & Cariou, 2013 To perform an evaluation of the evidence whether to use the cooling measures in patients with non-shockable cardiac arrest or not. 548 individuals from Finland who were 1-year post-arrest. Controlled randomized research on the control and intervention groups. Evidence from descriptive studies. From 20% to 25% of the sample experienced positive neurological outcomes after TH. No detailed data regarding temperature management was provided.
Lascarrou et al., 2015 To define the risk-benefit ratio of applying TH. 22 ICUs from 22 healthcare institutions in France were researched. 584 patients took part in the research and were divided into two equal groups. Prospective nonrandomized design without blinded assessment was conducted together with a comparison of the two different temperature groups. Evidence from descriptive studies. The 32.5°-33.5° temperature group has revealed absolutely positive outcomes compared to the other controlled group. No limitations were observed in this study.
Shah, Zimmerman, Bullard, & Yenari, 2011 To compare mortality rates with the positive outcomes in the cases of TH application. Eight patients who suffered a cardiac arrest and were subjected to TH within 24-48 hours were researched in the article. The comparison and description of the TH application and absence of TH were conducted. Evidence from descriptive studies. From 60 to 85% of patients who underwent the cooling measures experienced better neurologic results. The timing was not provided, and some of the data were not presented.

Summary

The research articles were reviewed and analyzed to be able to find evidence to the issue whether therapeutic cooling measures would result in better nursing outcomes in patients who have been successfully resuscitated following a cardiac arrest compared to those who did not receive such treatment. Importantly, all of the articles studies the survival rate when the patients received therapeutic hypothermia within 48-72 hours.

All members of the sampling group were patients who experienced a cardiac arrest notwithstanding the presence of shock or arrest rhythm. As this type of issue requires a sufficient timeframe for investigation, there were not that many up-to-date articles; therefore, the year range of readings is from 2011 to 2015.

The study designs were different in all the four articles, though, all of them had either descriptive or comparative data. The article by Shah et al. (2011) was the only research article that could be placed lower than the other three in the levels-of-evidence table while it had only descriptive studies. Nonetheless, one of the articles was a prospective nonrandomized design without blinded assessment, and the others were prognostication and controlled randomized research. It should be noted that only the article composed by Deye et al. (2013) offered the evidence from a comparison of two sampling groups – control and intervention ones.

Nevertheless, it should be stressed out that three out of the four researches were conducted with the adequate sampling sizes. In these researches, the scientists were able to compare the results ensuring sufficient statistics while the article by Shah et al. (2011) had the sample of only eight patients, which cannot be considered enough to ensure the statistic associations. Thus, it can be concluded that the results are not valid and reliable enough.

The findings obtained from the research articles provided factual proof of the usability of therapeutic cooling measures since they result in better outcomes and survival rates. One of the important outcomes is that individuals should be provided with TH notwithstanding their arrest rhythm within 48 hours to achieve neurological recovery (Cronberg, 2013). Thus, all of the four readings evidenced that TH is an effective tool to reduce the risk of ischemic damage to the brain tissue.

Overall, the articles are comprehensive, but they have a number of limitations. For instance, one of the articles did not dwell upon the temperature management, which is critical in this issue and another article did not suggest any practical outcomes (Cronberg, 2013). As discussed earlier one of the readings did not have a sufficient sampling size; consequently, it was not possible for the authors to present the actual data and timing.

Nevertheless, the data obtained from the readings is strong enough to suggest a change in practice. It can be justified by the fact that, at present, not all health care institutions apply TH measures, but they are considered the only means of securing brain activity of patients who experienced out-of-hospital cardiac arrest (Lascarrou et al., 2015). Therefore, the articles’ results confirm the importance and necessity of furnishing therapeutic cooling measures to all the referring patients.

References

Cronberg, T., Horn, J., Kuiper, M., Friberg, H., & Nielsen, N. (2013). A structured approach to neurologic prognostication in clinical cardiac arrest trials. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21(45), 1-6. Web.

Deye, N., Arrich, J., & Cariou, A. (2013). To cool or not to cool non-shockable cardiac arrest patients: It is time for randomized controlled trials. Intensive Care Medicine, 39, 966–969. Web.

Lascarrou, J., Meziani, F., LeGouge, A., Boulain, T., Bousser, J., Belliard, G.,… Reignier, J. (2015). Therapeutic hypothermia after nonshockable cardiac arrest: the HYPERION multicenter, randomized, controlled, assessor-blinded, superiority trial. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(26), 2-12. Web.

Shah, M., Zimmerman, L., Bullard, J., & Yenari, M. (2011). Therapeutic hypothermia after cardiac arrest: Experience at an academically affiliated community-based veterans affairs medical center. Stroke Research and Treatment, 1- 8. Web.