title: Intracranial Pressure Increases During Rewarming Period After Mild Therapeutic Hypothermia in Postcardiac Arrest Patients.
abstract: Elevation of intracranial pressure (ICP) may worsen brain injury and neurological outcome. Studies on the use of therapeutic hypothermia (TH) for traumatic brain injury suggests that rapid rewarming from TH is associated with elevated ICP and poorer outcomes. However, few studies describe the time course of ICP changes during TH/rewarming after cardiac arrest (CA). In this study, we observed the changes in ICP during mild TH and rewarming after CA. Secondarily, we examined whether ICP is related to outcome. We studied comatose patients resuscitated from CA, who were treated with TH and who had ICP monitored. Target core temperature was 34°C for 24 h and target rewarming rate was 0.25°C/h. ICP and cerebral perfusion pressure (CPP) were monitored during the period. Outcome was rated as cerebral performance category. In nine patients, ICP increased during TH and rewarming (6.0 [4.0-9.0] mmHg to 16.0 [12.0-26.0] mmHg, p = 0.008). CPP did not change during the period (83.3 [80.1-91.0] mmHg to 74.3 [52.0-87.3] mmHg). Higher ICP was associated with worse outcomes (p = 0.009). All the cases with ICP >25 mmHg or CPP <40 mmHg died. Major ICP increment was observed during the rewarming period, although, some increase of ICP occurred even during the mild TH. ICP increment was higher in patients with worse outcomes.
authors.affiliation: 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Naito
authors.affiliation: 2 Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East , Tokyo, Japan .
authors.forename: Eiji
authors.initials: E
authors.lastname: Isotani
authors.affiliation: 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: 3 Emergency Center and Critical Care Unit , Tsuyama Chuo Byoin, Tsuyama, Japan .
authors.forename: Shingo
authors.initials: S
authors.lastname: Hagioka
authors.affiliation: 3 Emergency Center and Critical Care Unit , Tsuyama Chuo Byoin, Tsuyama, Japan .
authors.forename: Naoki
authors.initials: N
authors.lastname: Morimoto
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology; D003128:Coma / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D017694:Rewarming / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: cerebral edema; heart arrest; intracranial pressure