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Therapeutic hypothermia in the intensive cardiac care unit

Picchi, Andrea; Valente, Serafina; Gensini, Gianfranco

Journal of Cardiovascular Medicine: May 2015 - Volume 16 - Issue 5 - p 363–371
doi: 10.2459/JCM.0000000000000108

Therapeutic hypothermia has demonstrated to improve both survival and neurological outcome in patients who experienced an out-of-hospital cardiac arrest. Nevertheless, many aspects of its clinical application are still controversial. Current guidelines recommend to cool patients who survive a cardiac arrest due to either ventricular fibrillation or ventricular tachycardia, whereas the beneficial effect of lowering body temperature in nonshockable rhythms is still questionable due to the lack of randomized controlled trial involving this subgroup of patients. Although therapeutic hypothermia is often begun before hospital arrival, the optimal time to start cooling is still a matter of debate. Furthermore, different methods are available to low body temperature, but no direct comparisons are available to establish which device performs better than others, and a combination of external and endovascular cooling is usually preferred. The present review is aimed at summarizing the available evidence supporting the use in clinical practice of mild hypothermia in comatose survivors from cardiac arrest and at evaluating its adverse events and their treatment.

aDepartment of Cardiology, Misericordia Hospital, Grosseto

bDepartment of Medical and Surgical Critical Care, University of Florence, Florence, Italy

Correspondence to Andrea Picchi, MD, PhD, Department of Cardiology, Via Senese 161, 58100 Grosseto, ItalyTel: +39 0564483465; fax: +39 0564483464; e-mail:

Received 5 June, 2013

Revised 25 August, 2013

Accepted 19 March, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.