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 (Updated: 3/10/2014)
Click here to contact Ali Farzad, MD

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.

Want more emergency cardiology pearls? Follow me @alifarzadmd

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.

UMEM Educational Pearls

Title: Too early to give hypothermia the cold shoulder

References

Attachments