On the Shoulders of Giants
This was the original RCT that energized the therapeutic hypothermia (TH) movement. As we will discuss next Saturday, targeted temperature management and avoidance of hyperthermia appears to be what is most beneficial. In this RCT of 136 patients with cardiac arrest from ventricular fibrillation (VF) with ROSC, roughly half received TH to 32-24 degrees C vs the normothermia group. Both a good neurological outcome within 6 months and survival improved in the TH group. Short-term complications were the same in each group.
TH appeared to be a very promising therapy for patients resuscitated after VF. We have subsequently learned that strict normothermia and avoidance of hyperthermia was actually what mattered most. Tune in next Saturday!
Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002 Feb 21;346(8):549-56.
- Do this trial’s results seem too good to be true? Chris Nickson tackles some of the problems with this trial for LiTFL.
- EMCrit has a compelling post on the top 10 reasons to stop cooling to 33 degrees C.