Post-cooling fever in cardiac arrest patients treated with therpeutic hypothermia

Abstract

Background: Incidence and characteristics of post-cooling fever were rarely described. In this study, we analysed the possible link between cardiac arrest (CA), therapeutic hypothermia and fever.

Patients and Methods: Data of 11 post-CA pts were analysed. All hemodynamic, respiratory and laboratory data were collected. Hyperthermia was defined as a core (rectal) temperature exceeding 37.7[degrees]C,

Results: Of the 11 pts, there were 5 (45%) survivors and 6 (55%) non-survivors, 2 died of hemodynamic shock (first 24hrs), 4 died due to post-ischemic brain damage.

All pts were successfully cooled (33[degrees] for 24hrs). Rewarming procedure was uneventfull.

Eight (89%) pts developed hyperthermia at the end of rewarming. Six (75%) of them did so immediately, while the other 2 pts developed fever 2 to 5 hours after rewarming. Three (37.5%) pts showed short periods of fever (2 -10hrs), while the remaining 5 (62.5%) had fever for a few days. In all patients, WBC at admission were significantly increased whereas CRP only increased after 2-3 days ICU-admission, in 8 patients this occurred simultaneously with the post-cooling fever. In 7 of these 8 pts, antibiotic treatment was initiated. In 5 of 8 pts, pneumonia, prolonged weaning and awakening, but did not influence final mortality.

Conclusion: We found a 89% incidence of post-cooling fever, associated with ending of rewarming and increase in inflammatory parameters (CRP).