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ACEP Now: Vol 40 – No 11 – November 2021References
- Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549-556.
- Peberdy MA, Callaway CW, Neumar RW, et al. Post-cardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):S768-S786. Errata, Circulation. 2011;123(6):e237,124(15):e403.
- Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197-2206.
- Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015;372(20):1898-1908.
- Lascarrou J-B, Merdji H, Le Gouge A, et al. Targeted temperature management for cardiac arrest with nonshockable rhythm. N Engl J Med. 2019;381(24):2327-2337.
- Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384(24):2283-2294.
- Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2014;311(1):45-52.
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2 Responses to “Data Supporting Therapeutic Hypothermia for Cardiac Arrest Aren’t So Hot”
December 13, 2021
Douglas F. Kupas, MD, FACEP, FAEMSI find this article to dangerously oversimplify the science behind hypothermia after cardiac arrest.
The European TTM trials had significant weaknesses when comparing their study demographics with those of the average out-of-hospital cardiac arrests in most of the United States. (Maybe the OOHCAs in the authors country of New Zealand have different demographics that are biasing his interpretation?)The patients in TTM had incredibly high rates of bystander CPR, and the patients had very high rates of shockable initial rhythm – as well as other demographic differences from the US. Additionally, the time to cool patients was exceedingly long in the TTM trial which may have proven that “if you have delayed cooling, patients do no better than with no cooling”. The ongoing NIH funded ICECAP study requires cooling to target temperature within 4 hours of the 911 call – a huge difference from the leniency in cooling times in these TTM trials.
I am most concerned about the conclusion of this overly simplistic ACEP Now article that suggests that we should stop cooling based upon this trade journal article. If we applied the current evidence for epinephrine in cardiac arrest to this same scrutiny, there is more support for hypothermia. Emergency and critical care physicians should use caution in using this ACEP article (and the TTM trials) by themselves to make an argument for major changes in the practice of cooling.
January 23, 2022
Ryan RadeckiI think we probably agree more than we disagree on the science.
You mention ICECAP and other ongoing efforts to determine new delivery approaches with potential benefits – as do I, in the concluding paragraphs.
This summary should be construed, as you rightly note, to indicate the *current* approach – as likely reflected in the trial procedures – is unlikely to be of benefit to patients. I think we are actually arguing for the same thing – “major change in the practice of cooling”, and if evidence suggests greater alacrity is the beneficial element, that would be the change for which you argue.