In order to achieve the above, the committee has recognized the importance
- consulting non-cardiologists involved in the management of acute heart failure (internists, intensive-care specialists, emergency medicine physicians, anesthesiologists, general physicians…).
- building a relationship between different health-care professionals; involved in the management of acute heart failure (nurses, pharmacists, hospital administrators …).
Article of the Month
The Committee's article has been chosen by Dr Marek Banaszewski, FESC, from the Institute of Cardiology, Warsaw, Poland
Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest
Francis Kim , MD; Graham Nichol, MD, MPH; Charles Maynard, PhD; Al Hallstrom, PhD; Peter J. Kudenchuk, MD; Thomas Rea, MD, MPH; Michael K. Copass, MD; David Carlbom, MD; Steven Deem, MD; W. T. Longstreth Jr, MD; Michele Olsufka, RN; Leonard A. Cobb, MD
Dr Banaszewski commented:
Current guidelines recommend use of the mild therapeutic hypothermia in patients after resuscitation from prehospital shockable (VF) as well as nonshockable (asystole or PEA) cardiac arrest. The latest ESC guidelines for management of acute myocardial infarction in patients presenting with ST-segment elevation also recommend this therapetic method early after resuscitation of cardiac arrest patients who are comatose or in deep sedation (IB). The problem is that till now the optimal timing, duration, and method of cooling remain unclear. It seems logically, that early cooling (as soon as posibble), even during resusctitation might attenuate the reperfusion brain injury that begins with return of the spontaneous circulation (ROSC). The simple and most attracive method to perform prehospital, cooling is rapid infusion of cold intravenous fluid, because of its portability, ease in administration even by paramedics.
The objective of this large clinical trial was to determine whether prehospital cooling improves outcomes after resuscitation from cardiac arrest. The patients were randomly assigned to groups with (n=686) or without prehospital cooling (n=671), accomplished by infusing up to 2 L of 40C normal saline as soon as possble following ROSC with a goal temperature less than 340C. However, the intervention decreased mean core temperaturę by 1,20C and reduced the time to achive 340C by about 1 hour compared with the control group, survival to hospital discharge was similar among the studied groups. Prehospital cooling was also not associated with improved neurological status of full recovery or mild impairment at discharge in comparison to the standard care.
Nonetheless, there are important findings in context of safety and heart failure. The proportion of rearrest during transport was 26% in the intervention group compared with 21% in the control group (p=0.008). The intervention group had also significantly lower blood oxygenation parameters at admission, increased rate of pulmonary edema on first chest X-ray, and greater use of diuretics during the first 12 hours of hospitalization compared with the control group.
Although mild therapeutic hypothermia is recommended as a standard therapy for unconscious patients after cardiac arrest, the results of this study do not suport the strategy of prehospital cooling using respectively large amount of cold intravenous fluids to improve clinical outcomes. This strategy may also increase the risk of hemodynamic instability, especially pulmonary edema.
|Prof. A Mebazaa, FESC|
|C Mueller ||FESC (Basel, CH) ||G Ambrosio||FESC (Perugia, IT)||B Yilmaz||(Sivas, TR)|
|J Masip||FESC (Barcelona, ES)||J Spinar||FESC (Brno, CZ) ||H Skouri||(Beirut, LB)|
|A Arutyunov||(Moscow, RU)||V P Harjola||FESC (Helsinki, FI)||S Collins||SAEM|
(Des Plaines, US)
|M Banaszewski||FESC (Warsaw, PL)||A Ristic||(Belgrade, RS)|| || |
|S Anker||FESC (Berlin, DE) (ex-officio)|| || |
Mechanical Circulatory Support devices in heart failure - Programme- 27-28 April 2012 Wroclaw, Poland
International consensus on pre-hospital & initial management of acute heart failure - Common standpoints for emergency physicians and cardiologists - 15-16 March 2013 Munich, Germany
- Finalise the position paper on AHF "call for action" of the European Federation of Internal Medicine, the European Society of Emergency Medicine, the European Society of Intensive care Medicine, the primary care physicians WONCA and the Council of Cardiology Practice of the ESC.
- Publish the paper on "Recommendations for admission in CCU and ICU" involving same societies
- Conduct a survey on the impact of devices in the outcome in acute heart failure patients in conjunction with ESICM and European Society of Cardiac Surgeons
- Write a practical recommendation on "organ dysfunction" in acute heart failure in conjunction with ESICM