Cold fluids during cardiac arrest: faster cooling but not better outcome!

Excerpt

In the current issue of Intensive Care Medicine, Debaty and coworkers report the results of a very innovative strategy aiming to decrease post-anoxic brain injury [1], which accounts for the vast majority of deaths in patients resuscitated from a cardiac arrest (CA) [2]. Anoxo-ischemic damages are mainly caused by a reperfusion injury called “post-cardiac arrest syndrome” responsible for a cascade of pathophysiological mechanisms that especially damage the brain [3]. This has stimulated intense research (experimental and clinical) over the last 30–40 years aiming to limit the worsening of these neurological lesions occurring during the post-CA period [3], which culminated 10 years ago with the publication of two randomized landmark trials demonstrating that therapeutic hypothermia (TH) post-CA was an effective treatment in getting more neurologically intact survivors [4, 5]. This led to a rapid change in international recommendations on the management of patients initially surviving CA [6]. Based on clinical evidence, the latest international guidelines recommend that most comatose adult patients with spontaneous circulation after out-of-hospital CA (OHCA) should be cooled to 32–34 °C for 12–24 h [7]. However, a recent very well performed randomized trial (the TTM trial) compared two levels of TH, and found no differences in outcome between 33 and 36 °C [8, 9]. …