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Effects of therapeutic hypothermia and kinetics of serum protein S100B after cardiopulmonary resuscitation


1,University of Pécs Department of Anaesthesia and Intensive Therapy

DOI: 10.22514/SV102.122015.7 Vol.10,Issue 2,December 2015 pp.109-130

Published: 14 December 2015

*Corresponding Author(s): ÁKOS MÉREI E-mail:


Introduction. Post-resuscitation care is regulated by international guidelines. A milestone of these is the application of therapeutic hypothermia (TH). The aims of our study were: to determine the 30-day-mortality for our patients, to monitor the efficacy and effects of TH, and to investigate serum protein S100B – as an early prognostic marker.

Materials and Methods. In our study, 57 patients, treated after cardiopulmonary resuscitation (CPR) on a multidisciplinary intensive care unit, were included. Patients were divided into groups who received and who didn’t receive TH. 30-day-mortality was determined as an end-point. Effects of TH were monitored using statistical analysis according to clinical parameters and laboratory tests. Serum protein S100B levels were measured with ELISA technique on 20 randomised patients at

admission and the 1st, 3rd and 5th day after CPR.

Results. Total 30-day-mortality was 74%. TH did not reduced the 30-day-mortality (73% vs. 74%, p>0.05). We found a significant correlation between TH and serum lactate concentration after admission (0h,

p=0.006) and at 12 (p=0.045) and 36 (p=0.049) hours after CPR. On the

3rd (p=0.005) and 4th (p=0.043) day after CPR, as a result of TH, platelet count was significantly higher compared to normothermic samples. There was no significant difference in protein S100B levels between the normothermic and TH group and protein S100B levels did not correlate with 30-day-mortality.

Conclusion. Despite recommendations of international guidelines, we cannot prove the beneficial effect of TH, or a correlation of protein S100B levels with a positive outcome.


cardiac arrest, cardiopulmonary resuscitation, post-resuscitation care, therapeutic hypothermia, protein S100B

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ÁKOS MÉREI,BÁLINT JÁNOS NAGY,GÁBOR LÁSZLÓ WOTH,NÓRA ZSIDÓ,JÁNOS LANTOS,DIANA MÜHL. Effects of therapeutic hypothermia and kinetics of serum protein S100B after cardiopulmonary resuscitation. Signa Vitae. 2015. 10(2);109-130.


1. Reith S, Marx N. Therapeutische Hypothermie nach Reanimation TT –Therapeutic hypothermia after resuscitation. Dtsch med Wochenschr 2010;135(47):2355–60.

2. Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al. Kurzdarstellung. Notfall + Rettungsmedizin [Internet]. 2010 Nov


3. Orban JC, Cattet F, Lefrant JY, Leone M, Jaber S, Constantin JM, et al. The Practice of Therapeutic Hypothermia after Cardiac Arrest in France: A National Survey. PLoS One; 2012 Jan;7(9):e45284.

4. Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg R a, Böttiger BW, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation. Circulation 2008 Dec 2 118(23):2452–83.

5. Schneider a, Popp E, Teschendorf P, Böttiger BW. Therapeutische Hypothermie. Anaesthesist 2008;57(2):197–206; quiz 207–8.

6. Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW, Kloek WGJ, Billi J, et al. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation. Resuscitation 2003 Jul


7. Gunn a. J, Thoresen M. Hypothermic Neuroprotection. NeuroRx


8. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“). Notfall + Rettungsmedizin 2010 Nov 13;13(7):559–620.

9. Böttiger BW, Möbes S, Glätzer R, Bauer H, Gries a, Bärtsch P, et al. Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humans. Circulation 2001 Jun 5;103(22):2694–8.

10. Nolan JP, Soar J, Zideman D a, Biarent D, Bossaert LL, Deakin C, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2010 Oct;81(10):1219–76.

11. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G SK. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346(8):557–63.

12. THE HYPOTHERMIA AFTER CARDIAC ARREST STUDY GROUP. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346(8):549–56.

13. Oddo M, Schaller M-D, Feihl F, Ribordy V, Liaudet L. From evidence to clinical practice: Effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med 2006 Aug ;34(7):1865–73.

14. Bernard S a, Jones BM, Horne MK. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med 1997 Aug;30(2):146–53.

15. 15. Storm C, Steffen I, Schefold JC, Krueger A, Oppert M, Jörres A, et al. Mild therapeutic hypothermia shortens intensive care unit stay of survivors after out-of-hospital cardiac arrest compared to historical controls. Crit Care 2008 Jan;12(3):R78.

16. 16. Don CW, Longstreth W, Maynard C, Olsufka M, Nichol G, Ray T, et al. Active surface cooling protocol to induce mild therapeutic hypothermia after out-of-hospital cardiac arrest: A retrospective before-and-after comparison in a single hospital. Crit Care Med 2009;37(12):3062–9.

17. 17. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. N Engl J Med 2013;369(23):2197–206.

18. 18. Buijs EAB, Verboom EM, Top APC, Andrinopoulou E-R, Buysse CMP, Ince C, et al. Early microcirculatory impairment during therapeutic hypothermia is associated with poor outcome in post-cardiac arrest children: A prospective observational cohort study. Resuscitation


19. Arrich J, Sterz F, Fleischhackl R, Uray T, Losert H, Kliegel A, et al. Gender modifies the influence of age on outcome after successfully resuscitated cardiac arrest: a retrospective cohort study. Medicine

(Baltimore) 2006 Sep;85(5):288–94.

20. Meaney P a, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg R a. Rhythms and outcomes of adult in-hospital cardiac arrest. Crit Care Med 2010 Jan;38(1):101–8.

21. Khan NU, Razzak J a, Ahmed H, Furqan M, Saleem AF, Alam H, et al. Cardiopulmonary resuscitation: outcome and its predictors among hospitalized adult patients in Pakistan. Int J Emerg Med 2008


22. Kutsogiannis DJ, Bagshaw SM, Laing B, Brindley PG. Predictors of survival after cardiac or respiratory arrest in critical care units. Can Med Assoc J 2011 Oct;183(14 ):1589–95.

23. Lundbye JB, Rai M, Ramu B, Hosseini-Khalili A, Li D, Slim HB, et al. Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms. Resuscitation 2012;83(2):202–7.

24. Hassan TB, Hickey FG, Goodacre S, Bodiwala GG. Prehospital cardiac arrest in Leicestershire. J Accid Emerg Med 1996;251–5.

25. Wijdicks EFM, Bamlet WR, Maramattom B V, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Ann Neurol 2005;58(4):585–93.

26. Yannopoulos D, Kotsifas K, Aufderheide TP, Lurie KG. Cardiac arrest, mild therapeutic hypothermia, and unanticipated cerebral recovery. Neurologist 2007 Nov;13(6):369–75.

27. Liu H, Liu Y, Xu Y, Xue Y. Prognostic evaluation of bispectral index in patients following cardiopulmonary resuscitation. Exp Ther Med 2013 Mar;5(3):907–11.

28. Bach F, Mertzlufft F. Therapeutic hypothermia and acid-base management. Anaesthesist 2007 Apr;56(4):366–70.

29. Spiel AO, Kliegel A, Janata A, Uray T, Mayr FB, Laggner AN, et al. Hemostasis in cardiac arrest patients treated with mild hypothermia initiated by cold fluids. Resuscitation 2009;80(7):762–5.

30. Rothermundt M, Peters M, Prehn JHM, Arolt V. S100B in brain damage and neurodegeneration. Microsc Res Tech 2003;60(6):614–32.

31. Schoerkhuber W, Kittler H, Sterz F, Behringer W, Holzer M, Frossard M, et al. Time course of serum neuron-specific enolase. A predictor of neurological outcome in patients resuscitated from cardiac arrest. Stroke 1999 Aug 1;30(8):1598–603.

32. Shinozaki K, Oda S, Sadahiro T, Nakamura M, Abe R, Nakada T, et al. Serum S-100B is superior to neuron-specific enolase as an early prognostic biomarker for neurological outcome following cardiopulmonary resuscitation. Resuscitation 2009;80(8):870–5.

33. Rainey T, Lesko M, Sacho R, Lecky F, Childs C. Predicting outcome after severe traumatic brain injury using the serum S100B biomarker: Results using a single (24h) time-point. Resuscitation 2009;80(3):341–5.

34. Bloomfield SM, McKinney J, Smith L, Brisman J. Reliability of S100B in predicting severity of central nervous system injury. Neurocrit Care 2007 Jan;6(2):121–38.

35. Song KJ, Shin S Do, Ong MEH, Jeong JS. Can early serum levels of S100B protein predict the prognosis of patients with out-of-hospital cardiac arrest? Resuscitation 2010;81(3):337–42.

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