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Temperature control after cardiac arrest : friend or foe
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Nolan, Jerry P. and Soar, Jasmeet (2022) Temperature control after cardiac arrest : friend or foe. Current Opinion in Critical Care, 28 (3). pp. 244-249. doi:10.1097/MCC.0000000000000943 ISSN 1070-5295.
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Official URL: http://dx.doi.org/10.1097/MCC.0000000000000943
Abstract
Purpose of review
Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Best practice has been to cool these patients and control their temperature at a constant value in the range of 32–36 oC for at least 24 h. But the certainty of the evidence for this practice is increasingly being challenged. This review will summarize the evidence on key aspects of temperature control in comatose postcardiac arrest patients.
Recent findings
The Targeted Temperature Management 2 (TTM-2) trial documented no difference in 6-month mortality among comatose postcardiac arrest patients managed at 33 oC vs. targeted normothermia. A systematic review and meta-analysis completed by the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) concluded that temperature control with a target of 32–34 °C did not improve survival or favourable functional outcome after cardiac arrest. Two observational studies have documented an association between predicted moderate hypoxic–ischaemic brain injury and better outcome with temperature control at 33–34 oC compared with 35–36 oC.
Summary
We suggest actively preventing fever by targeting a temperature 37.5 oC or less for those patients who remain comatose following return of spontaneous circulation (ROSC) after cardiac arrest.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Current Opinion in Critical Care | ||||
| Publisher: | Lippincott Williams & Wilkins | ||||
| ISSN: | 1070-5295 | ||||
| Official Date: | June 2022 | ||||
| Dates: |
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| Volume: | 28 | ||||
| Number: | 3 | ||||
| Page Range: | pp. 244-249 | ||||
| DOI: | 10.1097/MCC.0000000000000943 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||
| Copyright Holders: | Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. |
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