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Revista EMERGENCIAS




  REVISTA EMERGENCIAS SEMES > ARTÍCULOS

Emergencias 2012; 24: 7-12

Prehospital induction of moderate hypothermia after cardiac resuscitation can increase survival without increasing neurologic impairment: a case-control study

ERVIGIO CORRAL TORRES , FRANCISCO FERNÁNDEZ AVILÉS , ESTEBAN LÓPEZ DE SA , JUAN CARLOS MARTÍN BENÍTEZ , JUAN CARLOS MONTEJO , ROBERTO MARTÍN REYES , RAFAEL SAAVEDRA CERVANTES

SAMUR Protección Civil. Madrid, Spain. Hospital Gregorio Marañón. Madrid, Spain. Hospital La Paz. Madrid, Spain. 4Hospital 12 de Octubre. Madrid, Spain. Hospital Clínico San Carlos. Madrid, Spain. Fundación Jiménez Díaz. Madrid, Spain.

Objectives: To assess the effect of early prehospital emergency responder implementation of moderate hypothermia on neurologic outcome in patients recovering from cardiac arrest. Methods: Case-control comparative study. The cases were the first 40 patients in cardiorespiratory arrest in whom hypothermia was induced in the ambulance after resuscitation by responders from the Citizen Protection Emergency Service of Madrid (SAMUR); hypothermia was also later used in the hospital. The controls were the last 40 patients in cardiorespiratory arrest who were resuscitated by the SAMUR responders before the prehospital hypothermia protocol had been established; hypothermia was later induced after the control patients’ arrival at the hospital. Patients whose cardiorespiratory arrest had neurologic causes were excluded given that the effect on neurologic outcome was under evaluation. The Cerebral Performance Category scale was used to assess impairment. A grade 1 or 2 assessment was considered to indicate a good neurologic outcome. Results: Neurologic outcome was good for 50% of the patients in whom hypothermia was induced early; outcome was good for 27.5% of the control patients (P=.039). The significant difference between cases and controls was maintained regardless of whether the initial heart rhythm was shockable (58.3% of such cases had good neurologic outcomes with early hypothermia vs 37.5% of the controls with shockable rhythm) or not (42.8% of such cases had good outcomes vs 14.2% of the controls with nonshockable rhythm). Conclusions: Our findings show a significant relationship between prehospital induction of moderate hypothermia and a higher probability of neurologic recovery (performance categories 1 and 2). If moderate hypothermia is initiated before arrival at the hospital, the likelihood of good neurologic recovery is 2.6-times greater.


Texto Completo: http://www.semes.org/revista/vol24_1/4_ing.pdf


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