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induced hypothermia; targetted temperature management

may be regional or total body Indications: - cardiac arrest, after cardiopulmonary resuscitation (CPR) [1] - standard of care for patients who remain unconscious after cardiac arrest (MKSAP, NEJM) [3,4] - mild induced hypothermia may (or may not) improve outcomes [4,5,6] - targetted temperature of 33 C no better than 36 C or 37.5 C [3,7] - may benefit patients with non-shockable rhythms - targetted temperature management = prevention of hyperthermia [3] Benefit/risk: - cardiac arrest, after CPR [1] - number needed to treat (NNT) = 6 to save 1 life - no harm noted [1] Management: - cooling for 48 hours vs 24 hours not associated with better neurologic outcomes after cardiac arrest [2] - maintaining normothermia (targetted temperature management) may be noninferior to induced hypothermia

General

hypothermia clinical procedure

References

  1. The NNT: Mild Therapeutic Hypothermia for Neuroprotection Following Cardiopulmonary Resuscitation (CPR) http://www.thennt.com/nnt/hypothermia-for-neuroprotection-after-cardiac-arrest/ - Arrich J, Holzer M, Herkner H, Mullner M. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004128 PMID: 19821320
  2. Kirkegaard H et al. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: A randomized clinical trial. JAMA 2017 Jul 25; 318:341. PMID: 28742911 http://jamanetwork.com/journals/jama/article-abstract/2645105 - Callaway CW. Targeted temperature management after cardiac arrest: Finding the right dose for critical care interventions. JAMA 2017 Jul 25; 318:334. PMID: 28742888 http://jamanetwork.com/journals/jama/article-abstract/2645081
  3. NEJM Knowledge+ - Schenone AL, Cohen A, Patarroyo G et al Therapeutic hypothermia after cardiac arrest: A systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature. Resuscitation. 2016 Nov;108:102-110. Epub 2016 Aug 10. PMID: 27521472 Review. - Dankiewicz J, Cronberg T, Lilja G et al Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2021 Jun 17;384(24):2283-2294 PMID: 34133859 Free article. Clinical Trial. https://www.nejm.org/doi/pdf/10.1056/NEJMoa2100591 - Donnino MW, Andersen LW, Berg KM et al Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation. 2015 Dec 22;132(25):2448-56.Epub 2015 Oct 4. PMID: 26434495 Review. - Taccone F, Cronberg T, Friberg H et al How to assess prognosis after cardiac arrest and therapeutic hypothermia. Crit Care. 2014 Jan 14;18(1):202. PMID: 24417885 PMCID: PMC4056000 Free PMC article. Review.
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2015, 2018, 2022
  5. Cheung KW et al, Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post-cardiac arrest patients. Can J Emerg Med 2006, 8:329
  6. Hassager C et al. Duration of device-based fever prevention after cardiac arrest. N Engl J Med 2022 Nov 6; [e-pub] PMID: 36342119 https://www.nejm.org/doi/10.1056/NEJMoa2212528
  7. Nielsen N, Wetterslev J, Cronberg T et al Targeted temperature management at 33 C versus 36 C after cardiac arrest. N Engl J Med. 2013 Dec 5;369(23):2197-206 PMID: 24237006