Qafiti Fred N, Rubay David, Shin Rebecca, Lottenberg Lawrence, Borrego Robert
General Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA.
Trauma and Surgical Critical Care, University of Florida College of Medicine, Gainesville, USA.
Cureus. 2021 Jun 18;13(6):e15749. doi: 10.7759/cureus.15749. eCollection 2021 Jun.
Trauma by electricity imposes mechanical, electrical, and thermal forces on the human body. Often, the delicate cardiac electrophysiology is disrupted causing dysrhythmia and subsequent cardiac arrest. Anoxic brain injury (ABI) is the most severe consequence and the main cause of mortality following cardiac arrest. Establishing a working protocol to treat patients who are at risk for ABI after suffering a cardiac arrest is of paramount importance. There has yet to be sufficient exploration of combination therapy of therapeutic hypothermia (TH) and progesterone as a neuroprotective strategy in patients who have suffered cardiac arrest after electric shock. The protocol required TH initiation upon transfer to the ICU with a target core body temperature of 33°C for 18 hours. This was achieved through a combination of cooling blankets, ice packs, chilled IV fluids, nasogastric lavage with iced saline, and intravascular cooling devices. Progesterone therapy at 80-100 mg intramuscularly every 12 hours for 72 hours was initiated shortly after admission to the ICU. We present a case series of three patients (mean age = 29.3 years, mean presenting Glasgow Coma Score = 3) who suffered ventricular fibrillation (VF) cardiac arrest from non-lightning electric shock, and who had considerably improved outcomes following the TH-progesterone combination therapy protocol. The average length of stay was 13.7 days. The cases presented suggest that there may be a role for neuroprotective combination therapy in post-resuscitation care of VF cardiac arrest. While TH is well documented as a neuroprotective measure, progesterone administration is a safe therapy with promising, albeit currently inconclusive, neuroprotective effect. Future protocols involving TH and progesterone combination therapy in these patients should be further explored.
电击创伤会对人体施加机械、电和热力量。通常，脆弱的心脏电生理会受到干扰，导致心律失常及随后的心脏骤停。缺氧性脑损伤（ABI）是心脏骤停后最严重的后果和主要死亡原因。制定一个针对心脏骤停后有ABI风险患者的治疗方案至关重要。对于电击后心脏骤停的患者，作为一种神经保护策略，治疗性低温（TH）和孕酮的联合治疗尚未得到充分探索。该方案要求在转至重症监护病房（ICU）后立即开始进行TH治疗，目标核心体温为33°C，持续18小时。这是通过使用降温毯、冰袋、冷藏静脉输液、用冰盐水进行鼻胃灌洗以及血管内冷却装置来实现的。在入住ICU后不久，开始每12小时肌肉注射80 - 100毫克孕酮，持续72小时。我们报告了一个包含三名患者的病例系列（平均年龄 = 29.3岁，平均初始格拉斯哥昏迷评分 = 3），他们因非雷击电击发生心室颤动（VF）心脏骤停，在接受TH - 孕酮联合治疗方案后预后有显著改善。平均住院时间为13.7天。所呈现的病例表明，神经保护联合治疗在VF心脏骤停的复苏后护理中可能有作用。虽然TH作为一种神经保护措施已有充分记录，但孕酮给药是一种安全的治疗方法，具有有前景的神经保护作用，尽管目前尚无定论。未来应进一步探索涉及这些患者的TH和孕酮联合治疗方案。
