tailieunhanh - Báo cáo y học: "Formulas Prehospital therapeutic hypothermia in cardiac arrest: will there ever be evidence"

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: Formulas Prehospital therapeutic hypothermia in cardiac arrest: will there ever be evidence? | Available online http content 12 2 413 Letter Prehospital therapeutic hypothermia in cardiac arrest will there ever be evidence Joerg C Schefold Christian Storm and Dietrich Hasper Department of Nephrology and Medical Intensive Care Medicine Charité Universitatsmedizin Berlin Campus Virchow-Klinikum Augustenburger Platz 1 13353 Berlin Germany Corresponding author Joerg C Schefold schefold@ Published 9 April 2008 This article is online at http content 12 2 413 2008 BioMed Central Ltd See related research by Bruel et al. http content 12 2 R31 Bruel and colleagues nicely demonstrate that the infusion of 2 l cold saline during resuscitation is a feasible effective and safe measure to induce therapeutic hypothermia in out-ofhospital cardiac arrest 1 . Therapeutic hypothermia was induced in 33 eligible advanced life support patients before primary survival was foreseeable and was continued in 11 patients after intensive care unit admission. The authors conclude that a large randomised trial should be performed. The design of future trials on therapeutic hypothermia however seems challenged by the fact that withholding this treatment in a control arm might be considered unjustifiable from an ethical point of view. In the prehospital setting such a trial would require a large number of study patients to demonstrate an additional benefit. This is due to the fact that both a spontaneous decline in body core temperature occurs especially in the no-flow and low-flow phase and that the Critical Care 2008 12 413 doi ee6844 overall gain of time typically around 45 min may be considered marginal against the background of most published data indicating that target temperatures cannot be reached until about 6 to 8 hours later 2 3 . Given the optimistic view that prehospital cooling increases the number of favourable neurological outcomes from 55 4 to 60 about 750 patients would have to be included in a given randomised trial. .