Kosin Med J.  2023 Jun;38(2):144-150. 10.7180/kmj.22.130.

Targeted temperature management in a patient with suspected hypoxic-ischemic brain injury after successful resuscitation from cardiac arrest: a case report

• Kang C
• Lim WY
• Jung Yh
• Baik J

• KMID: 2543335
• DOI: http://doi.org/10.7180/kmj.22.130

Abstract

Hypoxic-ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurological disorders in survivors. Targeted temperature management (TTM) has been rigorously studied as a way to improve results compared to a normal body temperature for preventing secondary damage after HIBI. We report a case of successful TTM in a patient who was suspected to have HIBI after resuscitation from cardiovascular collapse due to respiratory failure during elective surgery under brachial plexus block with dexmedetomidine and remifentanil infusion. A 27-year-old male patient developed CA due to apnea during orthopedic surgery. TTM was performed in the surgical intensive care unit for 72 hours after resuscitation, and the patient recovered successfully. TTM application immediately after resuscitation from CA in patients with suspected HIBI may be an appropriate treatment.

Keyword

Brachial plexus block; Case reports; Cardiac arrest; Dexmedetomidine; Hypoxic ischemic brain injury; Resuscitation; Targeted temperature management

Figure

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  Fig. 1. Timeline of cardiopulmonary resuscitation and patient treatment with changes in vital signs, ABGA, electrolytes, glucose, and lactic acid. MRI, magnetic resonance imaging; SCIU, surgical intensive care unit; TTM, targeted temperature management; CPCR, cardiopulmonary cerebral resuscitation; BPB, brachial plexus block; DMT, dexmedetomidine; IV, intravenous; BIS, bispectral index; ABGA, arterial blood gas analysis; ER, emergency room; BP, blood pressure; ROSC, return of spontaneous circulation; b-MRI, brain MRI; BT, body temperature; HR, heart rate; SpO2, saturation by pulse oximetry; Hb, hemoglobin; PaCO2, arterial carbon dioxide pressure; O2 Sat, SaO2 saturation of arterial oxygen; PaO2, arterial oxygen pressure; Hct, hematocrit.

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  Fig. 2. Electroencephalography findings were suggestive of mild diffuse cerebral dysfunction. (A) During target temperature management. (B) After regaining of consciousness.

Reference

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