Perspective:

Therapeutic hypothermia (TH) is recommended in cardiac arrest guidelines. For patients resuscitated after out-of-hospital cardiac arrest, improvements in survival and neurologic outcomes were observed with relatively slow induction of TH. At present, the main methods of inducing and maintaining TH are surface cooling, endovascular heat-exchange catheters, and intravenous infusion of cold fluids. Surface cooling or endovascular catheters may be sufficient for induction of TH in patients resuscitated after out-of-hospital cardiac arrest. For patients with ST-segment elevation myocardial infarction (STEMI), intravenous infusion of cold fluids achieves target temperature very rapidly, but might worsen left ventricular function. More widespread use of TH would improve survival and quality of life for patients with out-of-hospital cardiac arrest; larger studies with more rapid induction of TH are needed in the STEMI population. In particular, transnasal evaporative cooling and peritoneal cooling may be effective methods for rapid induction of TH. Finally, local transcoronary TH could potentially convey cardioprotection even if initiated at the time of percutaneous coronary intervention while avoiding total-body hypothermia.