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Title: Too early to give hypothermia the cold shoulder

Category: Cardiology

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

Posted: 11/24/2013 by Ali Farzad, MD (Updated: 3/10/2014)

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.

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