Title: Too early to give hypothermia the cold shoulder<br/>Author: Ali Farzad<br/><a href='http://umem.org/profiles/faculty/737/'>[Click to email author]</a><hr/><div>
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<span style="font-family: arial, helvetica, sans-serif; font-size: 14px;">Hyperthermia after resuscitation from cardiac arrest is associated with poor outcomes and death. Induced mild hypothermia gained widespread use after two RCT's from 2002 (n=352) showed</span><span style="font-family: arial, helvetica, sans-serif; font-size: 14.44444465637207px;"> </span><span style="font-family: arial, helvetica, sans-serif; font-size: 14.44444465637207px;">improved </span><span style="font-family: arial, helvetica, sans-serif; font-size: 14px;">survival & neurological outcomes for select patients with OHCA. </span></div>
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<span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">In a new RCT (n=939), patients with ROSC after arrest were assigned to targeted temperature management at either 33°C or 36°C. Survival (51%) and a good neurologic outcome (47 to 48%) did not differ significantly between groups. However, cooling to 36°C is not the same as not regulating temperature and allowing hyperthermia. </span></span></div>
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<span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">In contrast to a decade ago, one half instead of one third of these patients can expect to survive hospitalization. Paying attention to temperature makes survival more likely than death when a patient is hospitalized after cardiac arrest. </span></span></div>
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<fieldset><legend>References</legend>
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<strong style="font-size: 12px;"><span style="font-family: arial, helvetica, sans-serif;">Newly Published RCT & Editorial </span></strong></div>
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<span style="font-size: 12px;"><span style="font-family: arial, helvetica, sans-serif;">- Nielsen N, Wetterslev J, Cronberg T, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. <i>N Engl J Med</i>. Nov 2013. </span></span></div>
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<span style="font-size: 12px;"><span style="font-family: arial, helvetica, sans-serif;">- Rittenberger JC, Callaway CW. Temperature Management and Modern Post-Cardiac Arrest Care. <i>N Engl J Med</i>. Nov 2013. </span></span></div>
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<span style="font-size: 12px;"><strong><span style="font-family: arial, helvetica, sans-serif;">Original RCTs</span></strong></span></div>
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<span style="font-size: 12px;"><span style="font-family: arial, helvetica, sans-serif;">- Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. <i>N Engl J Med</i>. 2002. </span></span></div>
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<span style="font-size: 12px;"><span style="font-family: arial, helvetica, sans-serif;">- Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. <i>N Engl J Med</i>. 2002. </span></span></div>
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<span style="font-size: 12px;"><strong><span style="font-family: arial, helvetica, sans-serif;">More on the deleterious effects of hyperthermia after cardiac arrest</span></strong></span></div>
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<span style="font-size: 12px;"><span style="font-family: arial, helvetica, sans-serif;">- Gebhardt K, Guyette FX, Doshi AA, et al. Prevalence and effect of fever on outcome following resuscitation after cardiac arrest. <i>Resuscitation</i>. 2013;84(8):1062–1067.</span></span></div>
</fieldset><fieldset><legend>Attachments</legend>
N_Engl_J_Med_2013_Nielsen.pdf (497 Kb)<br/><a href='http://umem.org/files/uploads/1311241245_N_Engl_J_Med_2013_Nielsen.pdf' target='_blank'>http://umem.org/files/uploads/1311241245_N_Engl_J_Med_2013_Nielsen.pdf</a><br/><br/>
N_Engl_J_Med_2013_Rittenberger.pdf (317 Kb)<br/><a href='http://umem.org/files/uploads/1311241245_N_Engl_J_Med_2013_Rittenberger.pdf' target='_blank'>http://umem.org/files/uploads/1311241245_N_Engl_J_Med_2013_Rittenberger.pdf</a><br/><br/>
N_Engl_J_Med_2002_Bernard.pdf (102 Kb)<br/><a href='http://umem.org/files/uploads/1311241246_N_Engl_J_Med_2002_Bernard.pdf' target='_blank'>http://umem.org/files/uploads/1311241246_N_Engl_J_Med_2002_Bernard.pdf</a><br/><br/>
N_Engl_J_Med_2002_Hypothermia_after_Cardiac_Arrest_Study_Group.pdf (172 Kb)<br/><a href='http://umem.org/files/uploads/1311241246_N_Engl_J_Med_2002_Hypothermia_after_Cardiac_Arrest_Study_Group.pdf' target='_blank'>http://umem.org/files/uploads/1311241246_N_Engl_J_Med_2002_Hypothermia_after_Cardiac_Arrest_Study_Group.pdf</a><br/><br/>
Resuscitation_2013_Gebhardt.pdf (551 Kb)<br/><a href='http://umem.org/files/uploads/1311241246_Resuscitation_2013_Gebhardt.pdf' target='_blank'>http://umem.org/files/uploads/1311241246_Resuscitation_2013_Gebhardt.pdf</a><br/><br/></fieldset>