Abstract
Hypothermia as a protectant of neurologic function in the treatment of cardiac arrest patients, although not a new concept, is now supported by two recent randomized, prospective clinical trials. The basic science research in support of the effects of hypothermia at the cellular and animal levels is extensive. The process of cooling for cerebral protection holds potential promise for human resuscitation efforts in multiple realms. It appears that, at least, those patients who suffer a witnessed cardiac arrest with ventricular fibrillation and early restoration of spontaneous circulation, such as those who were included in the European and Australian trials (discussed here), should be considered for hypothermic therapy.
Highlights
In two recent issues of New England Journal of Medicine, studies using hypothermia in patients following cardiac arrest (CA) to improve neurologic outcome were presented and debated [1,2,3,4,5,6,7,8]
Not a new issue, having first surfaced in the 1950s [9,10], hypothermia as a treatment strategy is potentially promising as a mechanism to curtail neurologic injury in specific, not fully defined, patient situations
As resuscitative measures have expanded, the need for options to improve neurologic function after CA is of paramount importance
Summary
Temp 15 min Terminal illness Unavailable for follow-up Enrolment in other study. Design problems exist in both of the two new trials of hypothermia for CA [1,2], namely potential bias (the treating physicians were unblinded), the sample sizes were small, and some of the treatment protocol aspects were different (such as the time of initiation of hypothermia [in the field versus hospital] and duration of hypothermia [12 versus 24 hours]) Critics of those studies have expressed concerns over several issues [3,4,5]: the hypothermia and normothermia groups may not have been well matched; the sample sizes were small; the subgroups of patients with CA analyzed were small percentages of the total number of CAs (13–19%); and side effects of hypothermia can be extensive. Until such larger trials are conducted, it is our opinion that the evidence, provided in prior feasibility/safety studies as well as in the combined European and Australian trials reported earlier this year, supports employing mild hypothermic therapy in the patient populations studied (those who have suffered witnessed ventricular fibrillation arrest, restoration of spontaneous circulation, etc.)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
