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Therapeutic hypothermia has been demonstrated to improve neurological outcome
and decrease mortality after out of hospital cardiac arrest in two randomized
controlled trials (click here for details).
Mode of action
- unclear
- moderate hypothermia did not significantly decrease cerebral metabolic
rate for oxygen in dog model of cardiac arrest
Indications
- out of hospital cardiac arrest
- initial rhythm ventricular fibrillation or pulseless ventricular
tachycardia
- patient comatose after return of spontaneous circulation
Contraindications
- shock after return of spontaneous circulation
- coagulopathy (but thrombolysis is not a contraindication)
Practical issues
- aim for core temperature 32-34°C
- cool patient as rapidly as possible
- keep cool for 12-24 h
- sedate, paralyze (to prevent shivering) and ventilate
- passive rewarming at end of period of hypothermia. Avoid rebound
hyperthermia
- use external cooling with ice packs, cooling blankets, cooling mattress,
cold towels and fanning
Complications
- moderate hypothermia is associated with increased incidence of arrhythmia,
sepsis and coagulopathy
- randomized controlled trials of hypothermia after cardiac arrest were not
adequately powered to demonstrate differences in complication rates between
control and hypothermic groups
Further
reading
J.
P. Nolan, et al. Therapeutic Hypothermia After Cardiac Arrest: An Advisory
Statement by the Advanced Life Support Task Force of the International Liaison
Committee on Resuscitation. Circulation 108 (1):118-121, 2003.
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