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Therapeutic hypothermia after cardiac arrest: where are we now?

Sunde, Kjetila; Søreide, Eldarb

Current Opinion in Critical Care: June 2011 - Volume 17 - Issue 3 - p 247–253
doi: 10.1097/MCC.0b013e3283453210
Cardiopulmonary resuscitation: Edited by Jerry Nolan
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Purpose of review Therapeutic hypothermia is widely recommended after cardiac arrest. In this review, we present publications reflecting the current discussion and opinions related to use of therapeutic hypothermia in comatose adult cardiac arrest survivors.

Recent findings The clinical outcome benefit of therapeutic hypothermia found in recent effectiveness studies is similar to that found in previous randomized trials. No single cooling method has been shown to be superior in terms of clinical outcomes. Therapeutic hypothermia is easy to perform and lacks severe side-effects or complications associated with mortality. Prehospital and intra-arrest cooling are being explored as a way to further improve outcome, although no clear relationship between timing of cooling and outcome has been documented.

Summary Although only proven beneficial for patients with ventricular fibrillation, the majority of centres today use therapeutic hypothermia also for comatose survivors with other initial rhythms. Some controversies still exist; the optimal target temperature, timing and duration of cooling have not yet been defined, and some researchers still think that the concept of therapeutic hypothermia is not satisfactorily proven scientifically. A new randomized study comparing temperature management to 36°C with 33°C is therefore underway.

aSurgical ICU Ullevål, Department of Anaesthesiology, Oslo University Hospital, Norway

bDepartment of Anaesthesiology and Intensive care, Stavanger University Hospital, Stavanger, Norway

Correspondence to Kjetil Sunde, MD, PhD, Surgical ICU Ullevål, Department of Anaesthesiology, Oslo University Hospital, N-0407 Oslo, Norway Tel: +47 22119678; fax: +47 22119634; e-mail: kjetil.sunde@medisin.uio.no

© 2011 Lippincott Williams & Wilkins, Inc.