We should not abandon therapeutic cooling after cardiac arrest

Excerpt

Therapeutic hypothermia (TH) has been used to treat post-hypoxic brain injury after cardiac arrest (CA) since the late 1950s. In 2002, two landmark prospective, randomized controlled trials (RCTs) confirmed the efficacy of TH for this indication [1, 2]. An 11-center trial in Europe reported 16% absolute improvement in outcome in patients with witnessed ventricular tachycardia/ventricular fibrillation (VT/VF) arrest with use of TH [1], and a four-center Australian study found 23% improvement [2]. More than 40 non-randomized studies have reported improved outcomes with TH [3]. A 5,317-patient registry in The Netherlands noted a 6.6% drop in mortality with TH implementation [4]. A Scandinavian registry with 986 patients reported 61% survival in witnessed VT/VF arrest, 92% with good neurological outcome [5]. A meta-analysis concluded that six patients had to be treated to achieve one additional case of good outcome [6]. On these bases, professional societies began recommending the use of TH in selected patients with CA [7, 8]. A Cochrane Review supported these guidelines and conclusions [9]. Further supporting evidence came from the field of neonatology, in which seven RCTs showed improved outcomes with TH in newborns with hypoxic injury [3]. …