ReviewThe role of hypothermia in post-cardiac arrest patients with return of spontaneous circulation: A systematic review☆
Section snippets
Background
Out-of-hospital cardiac arrest (OHCA) occurs in about 1 in 1500 adults in the developed world each year1; this means that about 375,000 people in Europe have a sudden cardiac arrest each year.2 The number of patients surviving to hospital discharge remains low: in a recent meta-analysis the aggregate survival rate was recorded between 6.7 and 8.4%.3 Among survivors, anoxic neurological injury is an important cause of morbidity.4 Over the last few years, mild hypothermia (32–34 °C for 12–24 h) has
Methods
The review was conducted in accordance with the International Liaison Committee on Resuscitation (ILCOR) 2010 evidence evaluation process, which has been well described.11 Expert review of the search strategy and findings were conducted by the worksheet evaluation experts who had been appointed specifically for this task. In keeping with all the ILCOR systematic reviews undertaken for 2010 CoSTR, a formal meta-analysis was not undertaken.
Results
The search identified 2991 papers. Seventy-seven studies met with the criteria for further review. Of these, four were LOE 1 (meta-analyses)14, 15, 16, 17; seven were LOE 1 (Randomized Controlled Trials),18, 19, 20, 21, 22, 23, 24 but six of these were from the same group of patients18; nine LOE 2 (non-randomized, concurrent controls)16, 25, 26, 27, 28, 29, 30, 31, 32; 15 LOE 3 (retrospective controls)7, 8, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45; 40 LOE 4 (no controls); and one LOE
Discussion
This review has identified some evidence that therapeutic hypothermia following cardiac arrest in comatose patients with ROSC improves mortality and neurological outcome. The strongest data remain those provided by the HACA Study Group,18 which showed both a reduction in mortality and improved neurological outcome at 6 months following out-of-hospital cardiac arrest where the initial rhythm was VF. These findings are supported by other, lower level, studies.25, 33, 35, 41 The extrapolation of
Authors conclusion and recommendation
This review has identified data on the use of therapeutic hypothermia to improve neurological outcome in comatose patients with ROSC after cardiac arrest. There is reasonable evidence that this therapy is effective for comatose survivors of VF/VT out-of-hospital cardiac arrest but there are only observational data to support its use after cardiac arrest from non-shockable rhythms or after in-hospital cardiac arrest. Cooling can be achieved in both the pre- and in-hospital setting and it can be
Disclaimer
This review includes information on resuscitation questions developed through the C2010 Consensus on CPR and ECC Science with Treatment Recommendations (CoSTR) process managed by the International Liaison Committee on Resuscitation.11 The questions were developed by ILCOR Task Forces, using strict conflict of interest guidelines.83 In general, each question was assigned to two experts to complete a detailed structured review of the literature, and complete a detailed worksheet. Worksheets were
Conflict of interest
JW – none; PM is a reimbursed consultant for Evidence Evaluation Expert position with ILCOR/AHA; and JN is Co-chair ILCOR and Editor-in-Chief of Resuscitation.
References (98)
- et al.
Out-of-hospital cardiac arrest in the 1990s: a population-based study in the Maastricht area on incidence, characteristics and survival
J Am Coll Cardiol
(1997) - et al.
Assessment of neurological prognosis in comatose survivors of cardiac arrest. BRCT I Study Group
Lancet
(1994) - et al.
Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest
Resuscitation
(1998) - et al.
Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest
Ann Emerg Med
(1997) - et al.
Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
Resuscitation
(2010) - et al.
Part 3: Evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
Resuscitation
(2010) - et al.
Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
Resuscitation
(2010) - et al.
Mild hypothermia induced by a helmet device: a clinical feasibility study
Resuscitation
(2001) - et al.
Effect of cooling after human cardiac arrest on myocardial infarct size
Resuscitation
(2009) - et al.
The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men
Resuscitation
(2004)
Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest
Am J Emerg Med
Influence of mild therapeutic hypothermia on the inflammatory response after successful resuscitation from cardiac arrest
J Crit Care
Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction
Resuscitation
Efficacy of therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation
Resuscitation
Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest
Resuscitation
The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest
Resuscitation
Improved prognosis after using mild hypothermia to treat cardiorespiratory arrest due to a cardiac cause: comparison with a control group
Rev Esp Cardiol
Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest
Resuscitation
Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced
Resuscitation
Therapeutic hypothermia for comatose survivors after near-hanging-a retrospective analysis
Resuscitation
Cold saline infusion and ice packs alone are effective in inducing and maintaining therapeutic hypothermia after cardiac arrest
Resuscitation
Hemostasis in cardiac arrest patients treated with mild hypothermia initiated by cold fluids
Resuscitation
Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study
Resuscitation
Effects of large volume, ice-cold intravenous fluid infusion on respiratory function in cardiac arrest survivors
Resuscitation
Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report
Resuscitation
Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest: a feasibility study
Resuscitation
Induction of therapeutic hypothermia during prehospital CPR using ice-cold intravenous fluid
Resuscitation
Prehospital induction of therapeutic hypothermia during CPR: a pilot study
Resuscitation
Out-of-hospital surface cooling to induce mild hypothermia in human cardiac arrest: a feasibility trial
Resuscitation
Feasibility and efficacy of a new non-invasive surface cooling device in post-resuscitation intensive care medicine
Resuscitation
Cold infusions alone are effective for induction of therapeutic hypothermia but do not keep patients cool after cardiac arrest
Resuscitation
A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest
Resuscitation
Rapid induction of therapeutic hypothermia using convective-immersion surface cooling: safety, efficacy and outcomes
Resuscitation
Early achievement of mild therapeutic hypothermia and the neurologic outcome after cardiac arrest
Int J Cardiol
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke
Resuscitation
Long-term neurological outcome after cardiac arrest and therapeutic hypothermia
Resuscitation
Part 4: Conflict of interest management before, during, and after the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
Resuscitation
A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGard System and Icy catheter following cardiac arrest
Resuscitation
Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital
J Am Coll Cardiol
Therapeutic hypothermia after prolonged cardiac arrest due to non-coronary causes
Resuscitation
Sudden cardiac death in the United States, 1989 to 1998
Circulation
Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis
Circ Cardiovasc Qual Outcomes
Targeted temperature management for comatose survivors of cardiac arrest
N Engl J Med
Cerebral resuscitation after cardiocirculatory arrest
Anesth Analg
Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group
Stroke
The well-built clinical question: a key to evidence-based decisions
ACP J Club
Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis
Crit Care Med
Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients
CJEM
Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation
Cochrane Database Syst Rev
Cited by (82)
Targeted temperature management after cardiac arrest is associated with reduced metabolism of pantoprazole – A probe drug of CYP2C19 metabolism
2022, Biomedicine and PharmacotherapyTargeted temperature management in the ICU: Guidelines from a French expert panel
2018, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :R1.2 We suggest considering TTM in order to improve survival with good neurological outcome in patients resuscitated from OHCA with non-shockable cardiac rhythm (asystole or pulseless electrical activity) and who remain comatose after ROSC. Rationale: Among 8 meta-analyses [14–20,28] and 4 reviews [13,21–23] on TTM after CA, 1 meta-analysis specifically analysed patients with initial non-shockable rhythm [28]. This meta-analysis found decreased hospital mortality in patients with TTM: RR 0.86 (95% CI 0.76–0.99), but there was no difference regarding neurological outcome: RR 0.96 (95% CI 0.90–1.02).
Mild hypothermia protects hippocampal neurons from oxygen-glucose deprivation injury through inhibiting caspase-3 activation
2018, CryobiologyCitation Excerpt :Hypoxic ischemic encephalopathy (HIE) is a common complication of cardiac arrest and refers to a cerebral injury resulting from inadequate oxygen supply to the brain [1,2]. Clinical and experimental studies have both shown that mild hypothermia (MH) improves neurological outcomes in HIE after cardiac arrest [3–6]. The protective mechanisms of MH on HIE are complex.
Controversies in Out of Hospital Cardiac Arrest?
2016, Interventional Cardiology ClinicsCardiac arrest and therapeutic hypothermia
2016, Trends in Cardiovascular Medicine
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.01.021.