Sydänpysähdyksestä elvytetyn potilaan tehohoito

Aims of the study Intensive care is usually necessary for the good survival of postresuscitation patients. The use of some intensive care methods can make the survival better. The main focus of this thesis was to analyze implementation of therapeutic hypothermia in Finnish intensive care units (ICU) and its impact on survival, impact of strict glucose control on the survival of postresuscitation patients, incidence of postresuscitation myocardial depression during therapeutic hypothermia and usefulness of serum NSE concentration for prognostication. Patients and methods Implementation of therapeutic hypothermia and survival of postresuscitation patients in ICUs in Finland was analyzed retrospectively using data from the Finnish Intensive Care Consortium quality database. Impact of glucose control on survival of postresuscitation patients was studied in a randomized controlled study of patients treated with therapeutic hypothermia (24 hours at 33°C) in HUCH ICUs (n = 90). The study patients were randomized to strict (4 6 mmol/l) or moderate (6 8 mmol/l) glucose control for the first 48 hours. The incidence of myocardial depression was studied in a retrospective analysis of hemodynamic data from clinical information system database of 120 postresuscitation patients treated with therapeutic hypothermia (24 hours at 33°C) in HUCH ICUs. Usefulness of serum NSE and some other factors as prognostic tools were analyzed retrospectively from laboratory database of 90 postresuscitation patients treated with ­therapeutic hypothermia (24 hours at 33°C) in HUCH ICUs. Results Therapeutic hypothermia was implemented widely in Finnish ICUs in a few years after international guidelines were published in 2003. In the same time, mortality of postresuscitation patients treated in ICUs decreased. Mortality or serum NSE concentration did not differ between patients treated with strict or moderate glucose control. However, strict glucose control increased risk of hypoglycemia. Myocardial depression, manifesting as low cardiac output (CI less than 1.5 l/min/m2), was ­observed during the first 12 hours in two thirds of patients monitored with pulmonary artery catheter. Other hemodynamic parametres did not differ. Serum NSE concentration at 48 hours after cardiac arrest and decreasing concentration at that time point correlated with neurologic outcome, but with 100% specificity, sensitivity was low. Conclusions Therapeutic hypothermia was implemented rapidly in Finnish ICUs, compared with other European countries or USA. This was associated with better outcome, but causality is uncertain. Strict normoglycemia during intensive care of postresuscitation patients is not necessary. The optimal goal for blood glucose level is not known. Myocardial depression manifesting as low cardiac output is common in postresuscitation patients, but difficult to detect without monitoring cardiac output. The impact of ­recognition and treatment of myocardial depression on outcome requires further studies. Serum NSE measured at least 48 hours after resuscitation can be used as a prognostic tool together with other methods.