Favorable Outcome and Survival Using a Hypothermia Protocol After Successful Cardiopulmonary Resuscitation
Bibliographic record
Abstract
Use of mild therapeutic hypothermia to goal 32 34 °C, after return of spontaneous circulation (ROSC) in cardiac arrest patients, has been shown to increase the rates of survival and favorable neurological outcomes [1, 2]. The American Heart Association (AHA) recommends mild therapeutic hypothermia after ROSC for out-of-hospital cardiac arrest with an initial documented rhythm of ventricular fibrillation (class I, level of evidence B) [3]. International resuscitation guidelines also support mild therapeutic hypothermia as the best medical practice for shockable rhythms in patients resuscitated from cardiac arrest due to ventricular fibrillation and pulseless ventricular tachycardia after ROSC [4]. Herein, we wish to notify the readers on a case of therapeutic hypothermia after ROSC in a young man associated with favorable neurologic outcome and survival. A 34-yearold electrical worker is brought to the emergency department (ED) by co-workers having been injured by electrical strike at work. On arrival in the ED, he had a Glasgow coma score (GCS) of 3/15 and dilated sluggish pupils. Additionally, there were no heartbeats or respiration. Cardiac monitoring revealed ventricular fibrillation and the patient received treatment with 150-J biphasic waveform shock. Cardiopulmonary resuscitation (CPR) was immediately instituted after the shock. After 2 min of CPR, ROSC was achieved and his rhythm has restored to sinus rhythm. Neither epinephrine nor antidysrhythmic agents were administered. He was resuscitated succesufully but yet remained comatose after CPR at the ED, following vital signs: GCS 8, heart rate 110/min, and blood pressure 80/50 mm Hg. Advanced cardiac life support measures were initiated (i.e., controlled intravenous fluid support, administration of dopamine, adequate oxygenation, and support of respiration with bag ventilation) following ROSC in the ED. Furthermore, therapeutic hypothermia protocol was started immediately with ice packs in the ED to decrease the patient’s temperature below 34 °C. Two hours after admission to the ED, he was transferred to the intensive care unit (ICU) for optimal care. Therapeutic cooling was maintained for 24 h by gel-circulation cooling pads (temperature management system; Artric Sun® 5000) in the ICU, and the patient was discharged home with mild neurologic deficit on ICU day 20. Therapeutic hypothermia is associated with favorable neurologic outcome and survival in patients who have experienced cardiac arrest and resuscitated succesufully, as it was in the present case. This therapy should be started as quickly as possible in post-cardiac arrest care patients, particularly with shockable cardiac arrest rhythms.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".