Temperature Management After Cardiac Arrest
- Donnino MW, Andersen LW, Berg KM, et al.
- Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation 2015;Oct 4:[Epub ahead of print].
The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed a systematic review to summarize the evidence on induced hypothermia in comatose post-cardiac arrest patients, and to provide a consensus on science statement and treatment recommendations. The Task Force aimed to provide answers to three essential clinical questions:
- Does Mild Hypothermia Compared With No Targeted Temperature Management Improve Outcome?
Answer: One randomized controlled trial and one quasi-randomized clinical trial provided low-quality evidence to use targeted temperature management after return of spontaneous circulation (ROSC) from out-of-hospital-cardiac arrest (OHCA) with an initial shockable rhythm. Indirect evidence extrapolated from studies of shockable OHCA may support this therapy in patients with nonshockable OHCA or in-hospital cardiac arrest. There is no direct evidence that suggests that one target temperature within the 32-36°C range is superior to another. There may be subpopulations of cardiac arrest patients who may benefit from lower (32-34°C) or higher (36°C) temperatures, but this remains unknown.
- Does Early (Prehospital) Induction of Targeted Temperature Management Affect Outcome?
Answer: In seven randomized controlled trials, providing overall moderate-quality evidence, prehospital induction of mild hypothermia did not reduce poor neurologic outcome or mortality after OHCA. The largest study found an increased risk of pulmonary edema and re-arrest with prehospital induction of mild hypothermia using rapid infusion of cold intravenous fluid. This led to the recommendation against routine use of prehospital cooling with rapid infusion of large volumes of cold intravenous fluid immediately after ROSC. Other cooling strategies and cooling during cardiopulmonary resuscitation in the prehospital setting have not been adequately studied.
- Does the Duration of Targeted Temperature Management Affect Outcome?
Answer: The Task Force found no data that could be used to compare different durations of targeted temperature management in patients. The duration should be at least 24 hours, as done in the two largest previous randomized controlled trials.
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