Hypothermia Recommended After VF Cardiac Arrest

Cooling to 32{degrees}C-34{degrees}C for 12-24 hours is advised for unconscious adults with spontaneous circulation.

A considerable amount of animal research has demonstrated the therapeutic benefits of induced hypothermia after cardiac arrest. The results of 2 recent human trials prompted the International Liaison Committee on Resuscitation (ILCOR) to issue a statement recommending hypothermia after cardiac arrest for selected patients.

In the 2 trials, researchers compared normothermia and hypothermia (cooling to 33°C for 12 or 24 hours) in 350 patients who were unconscious and intubated at presentation to an emergency department after resuscitation following out-of-hospital cardiac arrest that was caused by ventricular fibrillation. The numbers of patients needed to treat to achieve 1 extra survivor with a good neurologic outcome at 6 months (in one study) and at discharge (in the other) were 6 and 4, respectively. Based on the evidence to date, ILCOR recommends that unconscious adults with spontaneous circulation after out-of-hospital cardiac arrest that is caused by VF be cooled to 32°C-34°C for 12-24 hours. In addition, such cooling could be beneficial for patients with other rhythms or those who suffer in-hospital cardiac arrest.

Comment: ILCOR promised to respond rapidly to current research, and it did. Although the evidence is not clear from these 2 small trials, hypothermia likely is most beneficial when it is initiated as soon as hemodynamics stabilize. Hospitals should plan to cool patients on arrival, usually in the ED.

— James M. Christenson, MD, FRCPC

Published in Journal Watch Emergency Medicine August 13, 2003

Source

Nolan JP et al. Therapeutic hypothermia after cardiac arrest: An advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation. Resuscitation 2003 Jun; 57:231-5.
 

Nolan JP et al. Therapeutic hypothermia after cardiac arrest: An advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation [duplicate publication]. Circulation 2003 Jul 8; 108:118-21.