Intracranial pressure monitoring during hypothermia after cardiopulmonary resuscitation

Introduction

Two randomized clinical trials explored that induced hypothermia improved outcomes in adults with coma after resuscitation from ventricular fibrillation [1, 2]. In this study, we present the usefulness of intracranial pressure (ICP) monitoring to predict the patient's outcome after induced hypothermia.

Methods

Hypothermia (34°C, 48 hours) was induced in patients after the recovery of spontaneous circulation. The indication was as follows: motor response of Glasgow coma scale ≤ 5, at least one of the brain stem reflexes intact and age 15 to 80 years. ICP and oxygen saturation of the jugular vein (SjO₂) monitoring were performed during hypothermia.

Results

Hypothermia was induced in 23 patients (55%) after resuscitation. The outcome of nine patients (39%) was modified Rankin Scale 0 to 2, 11 patients (48%) were 3 to 5 and three patients (13%) were dead. ICP during hypothermia did not increase beyond 10 mmHg in neurologically good outcome patients (Figure 1). SjO₂ tended to be <80% in neurologically good outcome patients (Figure 2).

Figure 1

ICP monitoring during hypothermia.

Figure 2

SjO ₂ during hypothermia monitoring.

Conclusion

ICP monitoring during hypothermia was extremely useful to predict the patient's outcome. SjO₂ monitoring during hypothermia was also predictable about the patient's outcome.