A forgotten approach after cardiac arrest due to acute myocardial ınfarction: Neuroprotective therapeutic hypothermia

Abstract

In patients with spontaneous circulation after cardiopulmonary resuscitation, therapeutic hypothermia is defined as the reduction of body temperature to 32-34 ° C within the first 4-6 hours for neuroprotective purposes and to be maintained at this level for 12-24 hours after reaching the target temperature. Therapeutic hypothermia has been practiced since the 1940s. The aim of therapeutic hypothermia is to reduce cerebral edema, convulsive activity, metabolic demand and associated complications by providing low body heat. Therapeutic hypothermia is applied to increase life expectancy and quality of life. In out-of-hospital cardiac arrest, should be performed in comatose patients where initial rhythm is ventricular fibrillation and spontaneous circulation is returned. Herein, we present a 44 years old patient who had an aborted sudden cardiac death due to acute myocardial infarction and performing cardiopulmonary resuscitation for 30 minutes and discharged after 6 days with a successful therapeutic hypothermia.

Keywords

• Cardiac arrest,therapeutic hypothermia,external cooling

Akut miyokard infarktüsüne bağlı kardiyak arrest sonrası unutulan yaklaşım: Nöroprotektif terapötik hipotermi

Öz

Kardiyopulmoner resisütasyon sonrası spontan dolaşım sağlanan hastalarda, nöroprotektif amaçlı ilk 4-6 saat içinde vücut ısısının 32-34 °C’ye kadar indirildiği ve hedef ısıya ulaştıktan sonra 12-24 saat bu düzeyde tutulmasına terapötik hipotermi denir. Terapötik hipotermi 1940’lardan bu yana uygulanmaktadır. Terapötik hipoterminin amacı, düşük vücut ısısı sağlayarak serebral ödem, konvülziyon aktivitesi, metabolik talebi ve bunlarla ilgili gelişecek komplikasyonları azaltmaktır. Terapötik hipotermi yaşam beklentisi ve hayat kalitesini artırmak için uygulanır. Hastane dışı kardiyak arrestlerde başlangıç ritmin ventriküler fibrilasyon olduğu ve spontan dolaşımın geri döndüğü komatöz hastalarda yapılmalıdır. Burada, akut miyokard enfarktüsü nedeniyle ani kardiyak ölümle sonuçlanan ve 30 dakika süreyle kardiyopulmoner resisütasyon uygulanan ve 6 gün sonra başarılı bir terapötik hipotermi sonrası taburcu edilen 44 yaşında bir hasta sunuyoruz.

Anahtar Kelimeler

• Kardiyak arrest,terapötik hipotermi,eksternal soğutma

Kaynakça

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