Application of therapeutic hypothermia in the intensive care unit

Excerpt

Sir: The recent review of therapeutic hypothermia in the ICU [1] concluded that “Hypothermia can be an effective mode of neuroprotection in postischemic injury following CPR...” and characterised the evidence for this as Class I, based upon two randomised controlled trials published in 2002 [2, 3]. The primary outcome measure of Bernard and co-workers was “...survival to hospital discharge with sufficiently good neurological function to be sent home or to a rehabilitation facility...” [2] and for The Hypothermia after Cardiac Arrest Study Group, “...favourable neurologic outcome within six months after cardiac arrest...” [3]. Both studies reported unadjusted and covariate adjusted estimates for “good neurologic outcome”: for the Bernard et al. study these were, respectively, 49% versus 26% (p=0.046) and odds ratio 5.25 (95% CI, 1.47–18.76, p=0.011) and for The Hypothermia after Cardiac Arrest Study Group, a risk ratio of 1.41 (95% CI, 1.08–1.81), unchanged after adjustment. Of note was the decreased mortality in the hypothermic versus normothermic groups in both studies at their respective assessment time points: 51% versus 68% at hospital discharge [2] and 41% versus 55% at 6 months [3]. …