Abstract
The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM).The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research.The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 hours. There was insufficient evidence to recommend for or against temperature control at 32–36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.
Highlights
In comatose patients with presumed post-cardiac arrest brain injury[1] temperature control with a target of 32 to 36 °C body temperature was the only neuroprotective intervention to show a potential benefit and to enter international guidelines.[2–4]In recent years, the term targeted temperature management (TTM) has been used to describe temperature control after cardiac arrest
In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever for at least 72 hours
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce post resuscitation care guidelines resulting in the publication of the 2014 ERC-ESICM Advisory Statement on Prognostication in Comatose Survivors of Cardiac Arrest,[7] and in the 2015 and 2021 Guidelines on Post-Resuscitation Care
Summary
In comatose patients with presumed post-cardiac arrest brain injury[1] temperature control with a target of 32 to 36 °C body temperature was the only neuroprotective intervention to show a potential benefit and to enter international guidelines.[2–4]. The ERC and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce post resuscitation care guidelines resulting in the publication of the 2014 ERC-ESICM Advisory Statement on Prognostication in Comatose Survivors of Cardiac Arrest,[7] and in the 2015 and 2021 Guidelines on Post-Resuscitation Care The evidence informing both guidelines was based on ILCOR CoSTRs. In 2002, two randomised controlled trials (RCTs) showed that maintenance of core body temperature at 32–34 °C for 12–24 h in patients with post-cardiac arrest brain injury following resuscitation from out-of-hospital cardiac arrest (OHCA) due to witnessed shockable rhythm was associated with an improved survival to hospital discharge[8] and functional outcome at 6 months[9] when compared with standard care. Two authors (LWA, PTM, both members of the ILCOR ALS Task Force) were responsible for the methodological and statistical aspects
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