The use of hypothermia and outcome post cardiopulmonary resuscitation in 2014

In animal trials clinical outcome and histopathological damage of the brain tissue due to hypoxia after cardiac arrest was found to be reduced by mild therapeutic hypothermia.(1,2) The clinical milestone trials in 2002 also have found mild therapeutic hypothermia at 32°-34 °C for 12-24 hours to be neuroprotective in treatment of the post-cardiac arrest syndrome.(3-5) The last update of the international guidelines for resuscitation in 2010 stressed the benefit of hypothermia to almost all patients after cardiac arrest that remain comatose after return of spontaneous circulation (ROSC).(6) Over the past much data have been published showing a significant benefit for neurological outcome in clinical practice besides large trials. In our own centre we were able to reduce the rate of patients remaining in a persistent coma after cardiac arrest by an impressive number of approximately 50% after implementation of mild therapeutic hypothermia and to double therefore the group discharged with good outcome. But of course nowadays it is due to more than temperature management because we know that a complete treatment bundle, including early invasive coronary angiography, optimal ventilation, mean arterial pressure, glucose control, monitoring of diuresis and avoiding a severe acidosis will enlarge the numbers with good outcome.(7,8) Following a consensus statement of five different societies for critical care we now refer to targeted temperature management (TTM) instead of hypothermia.(9)