Steeplechase in Emergency Medical Care

Abstract

The great majority of patients who experience cardiac arrests expire after the event. Moreover, full neurological recovery occurs in only a small proportion of the survivors. Until recently no specific postarrest therapy was available to improve that outcome. Therapeutic cooling (32°C to 34°C for 12 to 24 hours) applied after cardiac arrest has been shown to improve this dismal situation. In 2002, two randomized clinical trials of mild therapeutic hypothermia applied to unconscious patients after successful resuscitation from cardiac arrest revealed that therapeutic cooling is capable of improving neurological outcome while reducing mortality.1,2 Both studies focused on an out-of-hospital population with ventricular-fibrillatory cardiac arrest and brief intervals to return of spontaneous circulation but remained comatose. These patients are considered the “sweetspot” population for a neuroprotective trial for this condition. Current International Liaison Committee on Resuscitation (ILCOR) guidelines reflect those inclusion criteria recommending that unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when their initial …