CPC determination after hypothermia

Q: 52 years old male coded in ER after he presented for chest pain. While the patient was prepared for cardiac catheterization, hypothermia was instituted. ER resident wrote an order for continuous infusion of midazolam. Ηурοthеrmiа ________________ the metabolism and excretion of midаzоlam. -  Select one

A) decreases

B) increases

Answer: A

Ηурοthеrmiа causes a decrease in the metabolism and excretion of midаzоlam. In patients who are bound to stay in therapeutic hypothermia protocol for 72 hours after cardiac arrest, it may take days for the drug to be cleared. It will hinder clinicians' ability to assess mental function after cardiac arrest for days or maybe even weeks. It is of vital importance to establish post-cardiac arrest brain injury (PCABI), also called hypoxic-ischemic brain injury (HIBI), after such an event.

One of the major outcomes that needs to be established is the cerebral performance category (CPC), particularly after extracorporeal cardiopulmonary resuscitation (ECPR). CPC score of 1 or 2 is preferred for survival. 

CPC is also called Glasgow–Pittsburgh cerebral performance category (CPC) scale:

CPC 1 or 2: Good neurological outcome

CPC 3 or 4: Neurological impairment

CPC 5: Brain death

#hemodynamic

#resuscitation

#ECMO

References:

1. Rey A, Rossetti AO, Miroz JP, et al. Late Awakening in Survivors of Postanoxic Coma: Early Neurophysiologic Predictors and Association With ICU and Long-Term Neurologic Recovery. Crit Care Med 2019; 47:85.

2. Hostler D, Zhou J, Tortorici MA, et al. Mild hypothermia alters midazolam pharmacokinetics in normal healthy volunteers. Drug Metab Dispos 2010; 38:781.

3. Abrams D, MacLaren G, Lorusso R, Price S, Yannopoulos D, Vercaemst L, Bělohlávek J, Taccone FS, Aissaoui N, Shekar K, Garan AR, Uriel N, Tonna JE, Jung JS, Takeda K, Chen YS, Slutsky AS, Combes A, Brodie D. Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications. Intensive Care Med. 2022 Jan;48(1):1-15. doi: 10.1007/s00134-021-06514-y. Epub 2021 Sep 10. PMID: 34505911; PMCID: PMC8429884.