Therapeutic hypothermia in the light of recent clinical studies

Abstract:

In the last 20 years, the treatment of patients after cardiac arrest has shaped the character of acute cardiac care. Throughout the world, numerous coronary care units have been transformed to full-operating intensive care units. Much impact on this process is due to therapeutic hypothermia, a method that has become deeply implemented in the post-arrest treatment protocols. Initial studies implied a positive impact of hypothermia on neurologic outcomes and survival of resuscitated patients with persistent coma. Following such results, therapeutic hypothermia was introduced in the European Society of Cardiology guidelines with the level of evidence Ib. However, recent studies raised the question whether hypothermia has an impact on outcome. In particular, Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest, provided robust evidence of lack of benefits of hypothermia. In this randomised, multicentric study, no difference in survival and neurologic outcome was observed between the group of patients treated with hypothermia (330C) and those in whom avoidance of hypothermia was performed. These data made an impact on current practice. Cooling to 330C is no longer supported, while the focus has shifted towards avoiding of hyperthermia. As fever is an integral part of post-resuscitation syndrome, active temperature management (sometimes including intravascular cooling) will remain a crucial part of the bundle of care for such patients.

Key words:
acute cardiac care; hypoxic-ischemic brain injury; out-of-hospital cardiac arrest; resuscitation; therapeutic hypothermia