UMEM Educational Pearls

Title: Too early to give hypothermia the cold shoulder

Keywords: Therapeutic Hypothermia, ROSC, Cardiac Arrest, Resuscitation (PubMed Search)

Posted: 11/23/2013 by Ali Farzad, MD (Emailed: 11/24/2013) (Updated: 3/10/2014)
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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 improved survival & neurological outcomes for select patients with OHCA.

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.

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.

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References

Newly Published RCT & Editorial

- Nielsen N, Wetterslev J, Cronberg T, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. N Engl J Med. Nov 2013.

- Rittenberger JC, Callaway CW. Temperature Management and Modern Post-Cardiac Arrest Care. N Engl J Med. Nov 2013.

Original RCTs

- Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002.

- Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002.

More on the deleterious effects of hyperthermia after cardiac arrest

- Gebhardt K, Guyette FX, Doshi AA, et al. Prevalence and effect of fever on outcome following resuscitation after cardiac arrest. Resuscitation. 2013;84(8):1062–1067.

Attachments

1311241245_N_Engl_J_Med_2013_Nielsen.pdf (497 Kb)

1311241245_N_Engl_J_Med_2013_Rittenberger.pdf (317 Kb)

1311241246_N_Engl_J_Med_2002_Hypothermia_after_Cardiac_Arrest_Study_Group.pdf (172 Kb)

1311241246_N_Engl_J_Med_2002_Bernard.pdf (102 Kb)

1311241246_Resuscitation_2013_Gebhardt.pdf (551 Kb)