ABSTRACT

Cerebral damage developing after out-of-hospital cardiac arrest, is a major cause of morbidity and mortality. Although hypothermic therapy demonstrated a positive effect on neurological outcomes, it is not yet in routine use in our country. In this study we reported three cases treated with endovascular cooling in our institution, following restoration of spontaneous circulation after out-of-hospital cardiac arrest. The mean return of spontaneous circulation (ROSC) time of 55-year- old two male, and a 46 year- old female patient were 15 and 13.3 minutes, respectively. Glascow coma score (GCS) was 3 points, and brain stem reflexes were absent in all cases. After placement of the cooling catheter (ALSIUS) into the femoral vein, the target temperature was set at 33°C. The average time between circulatory collapse and the start of hypothermic therapy was 115 minutes. The mean time to reach the target temperature was 285 minutes and rewarming was initiated after 18 hours. Normothermia (36°C) was achieved after an average of 6 hours and no complication was observed. Cranial MRI and electroencephalography (EEG) were performed. In two patients, 3 and 6 month- modified Rankin score (mRS) was 1, and Glasgow-Pittsburgh Outcome Score (GPOS) was 5. In the third case with resistant myoclonic seizures, and cranial MRI with widespread hypoxic damage, 3 and 6 month- mRS score was 5, GPOS was 2. In conclusion, endovascular therapeutic hypothermia after cardiac arrrest is a feasible and safe treatment method. Early initiation and rapid attainment of the target temperature are important considerations for effective treatment.

Keywords: Cardiac arrest, therapeutic hypothermia, endovascular cooling, external cooling, neurologic prognosis