Critical Care and Shock

Role of hypothermia in cerebral protection after cardiac arrest


Two randomized controlled studies have shown a meaningful improvement in outcome in survivors of out of hospital cardiac arrest who were treated with therapeutic hypothermia. At present proof of benefit is restricted to those with persistent coma after out of hospital arrest due to ventricular fibrillation or pulseless ventricular tachycardia. Important exclusion criteria are shock and primary coagulopathy (but not thrombolysis). In these patients the adverse effects of hypothermia (which include arrhythmias, infection and coagulopathy) are more likely to, at least partially, offset the benefits. At present external cooling is the recommended method of cooling but the use of rapid infusion of cold intravenous fluids may be useful in patients with good respiratory function.

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