Therapeutic hypothermia: the coolest part of the bundle of post-cardiac arrest care

Abstract

Organised post-cardiac arrest care targeting cardiovascular and neurological outcomes can improve survival to hospital discharge among victims who achieve return of spontaneous circulation (ROSC) after cardiac arrest. A recent international resuscitation review and consensus process has searched the published evidence to determine the impact of therapeutic hypothermia on morbidity and mortality in the context of patients with ROSC after cardiac arrest. Therapeutic hypothermia forms an integral element of this “bundle of care†that has been shown independently to improve outcome after adult witnessed out-of-hospital ventricular fibrillation (VF) cardiac arrest, and after neonatal hypoxicischaemic insult. Furthermore, two recent nonrandomised studies have shown the possible benefit of hypothermia after cardiac arrest from other initial rhythms in hospital and out of hospital, with further studies with historic controls also showing benefit for therapeutic hypothermia after out-of-hospital, allrhythm adult cardiac arrests.