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.