Yoshihiro Takeyama

Successful treatment of severe accidental hypothermia with cardiac arrest for a long time using cardiopulmonary bypass - report of a case

Accidental hypothermia is defined as an unintentional decrease in body temperature to below 35°C, and cases in which temperatures drop below 28°C are considered severe and have a high mortality rate. This study presents the case of a 57-year-old man discovered drifting at sea who was admitted to our hospital suffering from cardiac arrest. Upon admittance, an electrocardiogram indicated asystole, and the patients temperature was 22°C. Thirty minutes of standard CPR and external rewarming were ineffective in raising his temperature. However, although he had been in cardiac arrest for nearly 2 h, it was decided to continue resuscitation, and a cardiopulmonary bypass (CPB) was initiated. CPB was successful in gradually rewarming the patient and restoring spontaneous circulation. After approximately 1 month of rehabilitation, the patient was subsequently discharged, displaying no neurological deficits. The successful recovery in this case suggests that CPB can be considered a useful way to treat severe hypothermia, particularly in those suffering from cardiac arrest.

Preliminary report of contrast-enhanced computed tomography for patients with a percutaneous cardiopulmonary support system.

The purpose of this study was to investigate a suitable protocol of contrast-enhanced computed tomography (CECT) in cases with a cardiopulmonary support system. Contrast-enhanced computed tomography with intra-arterial injection (IAI) of contrast medium (CM) via a perfusion cannula showed sufficient contrast enhancement in 2 cases of cardiac decompensation (CD). Contrast-enhanced computed tomography with intravenous injection of CM showed insufficient and delayed contrast enhancement of the aorta in 2 cases of CD and 3 cases of pulseless electrical activity. We encourage administration of CM by means of IAI.

Indication of Brain Hypothermic Therapy in Cardiac Arrest

It is known that mild brain hypothermic therapy (BHT) has reduced ischemic brain damage in a variety of animal experiments. However, this mechanism of the nerve protection effect is not yet clear, and has not been definitively validated by clinical study. The purpose of this study is to determine the indications for this therapy by multivariate analysis in order to determine the characteristics of patients who can expect to benefit most from this therapy. The design of the study was that of an observational historical cohort study. Patients who were resuscitated, and were able to subsequently live for more than 1 month, were candidates for the study. Patients received either BHT (32°–34°C, n = 36) or brain normothermic therapy (BNT; 36°–37°C, n = 18). Data were gathered on multiple event and patient treatment characteristics. The patient outcome was measured by the 1-month Glasgow Outcome Scale (GOS). Data were analyzed using univariate and multivariate techniques. Overall, 47.2% of patients receiving BHT and 11.2% of BNT patients had a good neurological outcome (P < 0.05). Multivariate analysis of patient characteristics revealed relative improvements in patients with an arrest time of less than 20 min and Glasgow Coma Scale (GCS) score greater than 5. There were 19 patients in the BHT group who fulfilled these characteristics, and 73.8% of them had a good neurological outcome, which was significantly higher than the overall percentage of 47.2% (P < 0.05). Brain hypothermic therapy improved the 1-month neurological outcome in patients with an arrest time of less than 20 min and a GCS score greater than 5.

Brain Hypothermic Therapy Following Cardiopulmonary Bypass for Cardiac Arrest Patients Who Did Not Respond to Advanced Cardiovascular Life Support

Cardiac arrest patients who do not respond to advanced cardiovascular life support (ACLS) have a poor neurological outcome. However, some patients obtain good neurological recovery with a cardiac support device. We sought to determine the usefulness of brain hypothermic therapy (BHT) following cardiopulmonary bypass (CPB) in intractable cardiac arrest patients. We performed a retrospective cohort review of cardiac arrest patients with CPB who could not respond to ACLS between 1999 and 2003 in the emergency department. We have carried out BHT (34°C, 2 or 3 days) following CPB in patients who conformed to the following inclusion criteria: (1) their cardiac arrest was witnessed; (2) there was a failure to respond to ACLS; (3) successful intervention for original cause of cardiac arrest was performed; (4) circulation was stabilized following intervention. We evaluated their ECG on admission [ventricular fibrillation (VF) or non-VF] and neurological outcome [dead, vegetative state, severe disability (SD), moderate disability (MD), good recovery (GR)] as measured by the 1-month Glasgow outcome scale (GOS). Resuscitation with CPB was attempted in 30 patients (average age 52 years; 26 men, 4 women), and successfully achieved in 17 of them (57%). Eight of 15 patients who received BHT following CPB (53%) obtained a good neurological outcome (MD and GR), and 3 (20%) died during BHT. Nine of 24 patients who were VF on admission obtained a good neurological outcome (MD and GR: 38%). Six patients were non-VF, and none of them could be resuscitated. We concluded that BHT following CPB is useful for cardiac arrest patients with VF who do not respond to ACLS.