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Cardiac arrest is the most common cause of sudden natural death. Ischemia during cardiac arrest and reperfusion damage after resuscitation are often thesource prevention of permanent neurological impairment in survivors. Induced hypothernia opened the possibility of effective causal prevention of neurological damage. Induced hypothermia has been used as a standard treatmentat the Center for Intesive Internal Medicine (CIIM) since year 2004. We included patients who were treated at the CIIM in the period from 1 January2001 to 29 April 2005 following primary cardiac arrest. All enrolled patients fulfilled the criteria for treatment with induced hypothermia. The test group consisted of all patients treated after 1 January 2004, when induced hypothermia was adopted as the standard treatment method and the control group included all other patients from the observed time period. Survival, rate of neurological recovery and long-term neurological outcomes were compared, as well as the rate of complications. The final analysis included 123 patients, of whom 49 had been treated with hypothermia and 74 were control subjects. The two patient groups were comparable in terms of their basic characteristics and treatment (with the exception of controlled hypothermia). After half a year, 51% of patients who had been treated with hypothermia and 30% of those from the control group had a favorable neurological outcome (p=0.0223). In this period, 40.8% of patients treated with hypothermia and 60% of those from the control group died (p=0.0434). Noneof the treatment complications showed a statistically significant deviations in incidence between the two groups. 53% of patients treated with hypothermia and 79% of the control subjects were responsive in first three days (p = 0.03), while meaningful response was possible in 23% of patients treated with hypothermia and 72% of control subjects (p=0.001). (Abstract truncated at 2000 characters) Primarni srčni zastoj je najpogostejši vzrok nenadne naravne smrti pri odraslih. Ishemija možganov med zastojem in reperfuzijska poškodba po oživljanju, sta pogosto vir trajne nevrološke prizadetosti preživelih. Nadzorovana podhladitev nezavestnih bolnikov po oživljanju odpira možnost učinkovitega vzročnega preprečevanja nevrološke okvare. Na CIIM je v rutinski uporabi od začetka leta 2004. V raziskavo smo vključili bolnike, ki so se od 1.1. 2001 do 29. 4. 2005 zdravili na CIIM po primarnem srčnem zastoju in so ustrezali kriterijem za zdravljenje z nadzorovano podhladitvijo. Testno skupino so sestavljali hlajeni bolniki, kontrolno skupino pa nehlajeni bolniki(iz obdobja pred uvedbo hlajenja). Skupini smo primerjali glede na preživetje, nevrološki izid zdravljenja, pojavnost zapletov in hitrost nevrološkega okrevanja. V raziskavo smo vključili 123 bolnikov, 49 hlajenih in74 nehlajenih. Skupini sta primerljivi po temeljnih značilnostih bolnikov inpo načinu zdravljenja (z izjemo hlajenja). Pol leta po srčnem zastoju je bilo živih 59,2 % hlajenih in 40 % nehlajenih bolnikov (p = 0,043). Nevrološkiizid zdravljenja je bil pol leta po srčnem zastoju ocenjen kot uspešen pri 51 % hlajenih in 30% nehlajenih bolnikov (p=0,022). Skupini se nista statistično razlikovali glede na zaplete zdravljenja. Pri bolnikih, ki so nevrološko okrevali je bil čas do povrnitve odzivnosti krajši od tri dni pri 79 % nehlajenih in 53 % hlajenih (p=0,03). Čas do smiselnega kontakta je bil krajši od tri dni pri 72 % nehlajenih in 23 % hlajenih bolnikov (p=0,001).Nadzorovana podhladitev izboljšuje preživetje in nevrološki izid, obtem pa ne poveča pojavnosti zapletov pri bolnikih po primarnem srčnem zastoju, zdravljenih na CIIM. Pri bolnikih, ki se jim stanje zavesti izboljša,je nevrološko okrevanje počasnejše, če so zdravljeni z nadzorovano podhladitvijo.

Induced hypothermia after primary cardiac arrest (PCA) reduces post-ischemic reperfusion brain damage. At the Center for Intensive Internal Medicine (CIIM)of the Ljubljana Medical Center, it has been in routine use since the beginning of 2004. Patients who have undergone induced hypothermia to date, have exhibited better survival rates and neurological outcomes, which is in agreement with the results of foreign studies. After PCA, many patients have severe hyperglycemia with serum glucose levels above 11 mmol/1. However, the effectiveness of induced hypothermia in patients with severe hyperglycemia after PCA remains unresearched. The purpose of this study was to evaluate survival, neurological outcomes and complications of treatment in patients with hyperglycemia after PCA who were treated with induced hypothermia, with respect to serum glucose levels, and to compare them with results obtained before this method was introduced. Another aim was to objectify the effectiveness of treatment for hyperglycemia in patients after PCA treated at the CIIM. The study included patients who were treated at the CIIM after PCA during the period from 1 January 2001 to 31 December 2005 and who fulfilled the criteria for treatment with induced hypothermia. The test group consisted of cooled patients, while the control group included noncooled patients, i. e.those from the period before the introduction of cooling. Serum glucose levels were compared between the two groups and within each of the groups the relationship between serum glucose levels, and survival rates and neurologicaloutcomes was studied. In patients with severe hyperglycemia after PCA, survival rates, neurological outcomes, complications of treatment and effectiveness of insulin therapy were compared between the cooled and the noncooled group. (Abstract truncated at 2000 characters) Nadzorovana podhladitev po primarnem srčnem zastoju (PSZ) zmanjšuje ishemično in reperfuzijsko poškodbo možganov. V Centru za intenzivno interno medicino Kliničnega centra Ljubljana (CIIM) je v rutinski uporabi od začetka leta 2004.Pri doslej hlajenih bolnikih smo skladno z rezultati tujih raziskav ugotovili boljše preživetje in nevrološki izid. Mnogo bolnikov po PSZ ima hudohiperglikemijo s koncentracijo serumske glukoze nad 11 mmol/L. Kljub temu pa je še neraziskana učinkovitost nadzorovane podhladitve pri bolnikih s hudo hiperglikemijo po PSZ. Namen naše raziskave je ovrednotiti preživetje, nevrološki izid in zaplete pri bolnikih s hiperglikemijo po PSZ, z ozirom na koncentracijo serumske glukoze. Primerjati želimo bolnike pred in po uvedbi metode nadzorovanega podhlajevanja. Objektivizirati želimo tudi učinkovitost zdravljenja hiperglikemije pri bolnikih po PSZ, na CIIM. V raziskavo smo vključili bolnike, ki so se od 1.1. 2001 do 31.12. 2005 zdravili na CIIM po PSZ in so ustrezali kriterijem za zdravljenje z nadzorovano podhladitvijo. Testno skupino so sestavljali hlajeni bolniki, kontrolno skupino pa nehlajeni bolniki (iz obdobja pred uvedbo hlajenja). Primerjali smo koncentracije serumske glukoze in v vsaki od skupin ugotavljali povezavo med koncentracijamiserumske glukoze in preživetjem ter nevrološkim izidom. Pri bolnikih s hudo hiperglikemijo po PSZ smo primerjali preživetje, nevrološki izid, zaplete zdravljenja in učinkovitost inzulinskega zdravljenja med hlajenoin nehlajeno skupino. (Izvleček skrajšan na 2000 znakov)