Is it feasible and safe to wake cardiac arrest patients receiving mild therapeutic hypothermia after 12 hours to enable early neuro-prognostication. The Therapeutic Hypothermia and eArly Waking (THAW) trial protocol

Watson, Noel and Potter, Matt and Karamasis, Grigoris and Damian, Max and Pottinger, Richard and Clesham, Gerald and Gamma, Reto and Sayer, Jeremy and Robinson, Nicholas and Jagathesan, Rohan and Kabir, Alamgir and Tang, Kabir and Kelly, Paul and Macarroni, Maria and Kadayam, Ramabhadran and Nalgirkar, Raghu and Namjoshi, Gyanesh and Urovi, Sali and Pai, Anirudda and Waghmare, Kunal and Caruso, Vincenzo and Hampton-Till, James and Noc, Marko and Davies, John R. and Keeble, Thomas R. (2018) Is it feasible and safe to wake cardiac arrest patients receiving mild therapeutic hypothermia after 12 hours to enable early neuro-prognostication. The Therapeutic Hypothermia and eArly Waking (THAW) trial protocol. Therapeutic Hypothermia and Temperature Management, 8 (3). ISSN 2153-7933

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Official URL: https://doi.org/10.1089/ther.2017.0049

Abstract

Mild therapeutic hypothermia (MTH 33°C) post out-of-hospital cardiac arrest (OHCA) is widely accepted as standard of care. However, uncertainty remains around the dose and therapy duration. OHCA patients are usually kept sedated±paralyzed and ventilated for the first 24–36 hours, which allows for targeted temperature management, but makes neurological prognostication challenging. The aim of this study is to investigate the feasibility and safety of assessing the unconscious OHCA patient after 12 hours for early waking/extubation while continuing to provide MTH for 24 hours, and fever prevention for 72 hours by using an intravenous temperature management (IVTM) system and established conscious MTH anti-shiver regimens. This is a single-center, prospective, non-randomized observational study that will compare the results of early awakening (at 12 hours) with historical controls. A total of 50 consecutive unconscious survivors of OHCA, treated with MTH, who meet the Therapeutic Hypothermia and eArly Waking (THAW) inclusion criteria will be enrolled. The patient will receive MTH by using IVTM. After 12 hours of MTH, patients will be assessed by using strict clinical criteria to determine suitability for early waking and extubation. Once awake and extubated, MTH will continue for 24 hours with skin counter-warming and anti-shiver regimen followed fever prevention up to 72 hours. All patients will have serial electroencephalogram (EEG), somatic sensory potential, and neuro-biomarkers performed on admission to intensive care unit, 6 and 12 hours, then every 24 hours until 72 hours. The study has been approved by the National Research Ethics Service, Health Research Authority.

Item Type: Journal Article
Keywords: temperature management and early waking, therapeutic hypothermia, early positive neurological prognostication
Faculty: ARCHIVED Faculty of Medical Science (until September 2018)
Depositing User: Ian Walker
Date Deposited: 02 Feb 2018 15:44
Last Modified: 14 Nov 2019 16:09
URI: http://arro.anglia.ac.uk/id/eprint/702702

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