Mild Therapeutic Hypothermia in Out-of-Hospital Cardiac Arrest

Originally Published: Modern Resident, Dec/Jan 2010

Submitted by: Saadiyah Bilal, Publications Committee Co-Chair

Therapeutic hypothermia (TH) is the only intervention that has been shown to improve outcomes in comatose patients with out-of-hospital cardiac arrest. TH is now recommended by the American Heart Association (AHA) for the
treatment of neurological injury when the initial cardiac rhythm is ventricular fibrillation. The benefits of TH are not clearly established when the initial cardiac rhythm is asystole or PEA or when the arrest is due to a noncardiac cause such as asphyxia or drug overdose.

Due to the similarities between post cardiac arrest state and severe sepsis, early goal-directed hemodynamic optimization (EGDHO) combined with TH has been shown by Gaieski to improve outcome when compared to historic patients who would have been eligible for the combined therapy. Intravenous cooling techniques provide the requisite temperature of 32-34 degrees Celsius for 12-24 hours after arrest.

Conversely, TH has not been shown to reduce infarct size in patients undergoing PCI.

References:

1. Bernard SA. "Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia." N Engl J Med - 21-FEB-2002; 346(8): 557-63.
2. "Hypothermia after cardiac arrest: Expanding the therapeutic scope "Critical Care Medicine - Volume 37, Issue 7 Suppl (July 2009).
3. Gaieski DF. "Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest."- Resuscitation - 01-APR-2009; 80(4): 418-24.
4. "Therapeutic hypothermia for acute myocardial infarction: Past, present, and future" Critical Care Medicine - Volume 37, Issue 7 Suppl (July 2009).