R.E.B.E.L.EM - 28 Nov, 2016 - By Mastin A - Post Peer Reviewed By: Salim R. Rezaie
Ref: Schenone et al. Therapeutic Hypothermia After Cardiac Arrest: A Systematic Review/Meta-Analysis Exploring the Impact of Expanded Criteria and Targeted Temperature.
Resuscitation 2016; 108: 102 – 110. PMID: 27521472
"The use of therapeutic hypothermia (TH) has become part of the routine care of patients after return of spontaneous circulation (ROSC) from cardiac arrest (Use of the phrase Targeted Temperature Management has become more accepted). It became much more accepted after two separate trials were published in the New England Journal of Medicine in 2002 showing a survival benefit and improved neurologic outcome with use of TH. The use of TH has even been given a Level One recommendation by the American Heart Association for comatose post-arrest patients. Uncertainties still remain, however, such as what optimal temperature to use, and most recommendations on specifics related to TH are based on observational studies and expert opinion. So what is the actual evidence behind the use of TH?
Authors’ conclusions:
- “Our analysis proves there is a benefit of TH in a much broader spectrum of patients [from the original 2002 trials], and perhaps clinical guidelines need to strongly favor TH in all patients with cardiac arrest.”
- “At this time there is no evidence to support the use of one temperature level over others across the entire range of included temperatures of 32°C and 36°C during TH after OHCA.”
Take home points:
- Current evidence does support the use of targeted temperature management in ROSC patients after cardiac arrest
- The current optimal temperature remains elusive, but what is certain is that the prevention of fever is paramount."