Elsevier

Resuscitation

Volume 57, Issue 3, June 2003, Pages 231-235
Resuscitation

Therapeutic hypothermia after cardiac arrest.: An advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation

https://doi.org/10.1016/S0300-9572(03)00184-9Get rights and content

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ILCOR recommendations

On the basis of the published evidence to date, the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) made the following recommendations in October 2002:

  • Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32–34 °C for 12–24 h when the initial rhythm was ventricular fibrillation (VF).

  • Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest.

Clinical studies

In 2002 the results of two prospective randomised trials were published that compared mild hypothermia with normothermia in comatose survivors of out-of-hospital cardiac arrest [18], [19]. One study was undertaken in nine centers in five European countries [19]; the other was conducted in four hospitals in Melbourne, Australia [18].

The criteria for entry into these trials were similar: ROSC, patients remaining intubated and ventilated, with persistent coma after out-of-hospital cardiac arrest

Mechanisms of action

There are several possible mechanisms by which mild hypothermia might improve neurological outcome when used after reperfusion. In the normal brain, hypothermia reduces the cerebral metabolic rate for oxygen (CMRO2) by 6% for every 1 °C reduction in brain temperature >28 °C [21]. Some of this effect is due to reduced normal electrical activity [21], however, and after cardiac arrest in dogs, CMRO2 is not significantly reduced by mild hypothermia [22]. Mild hypothermia is thought to suppress many

Selection of patients

There seems to be good evidence (Level 1 [see Appendix A]) to recommend the use of induced mild hypothermia in comatose survivors of out-of-hospital cardiac arrest caused by VF. Selection criteria for treatment were narrowly defined in the best evidence used and thus should be considered carefully when deciding to treat.

Several specific questions remain unanswered despite the results of these recently published controlled trials, previous clinical studies, and supporting experiments in animals.

Summary: ILCOR recommendations

On the basis of the published evidence to date, the ILCOR ALS Task Force has made the following recommendations:

  • Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32–34 °C for 12–24 h when the initial rhythm was VF.

  • Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest.

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    Every effort has been made to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement has been co-published in the 8 July 2003, issue of Circulation. This statement was approved by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation in April 2003.

    1

    Member of the Pediatric Life Support Task Force.

    2

    Members of the ALS Task Force: W.G.J. Kloeck, Chair (Resuscitation Council of Southern Africa [RCSA]); J. Billi, MD (American Heart Association [AHA]); B.W. Böttiger (European Resuscitation Council [ERC]); P.T. Morley (Australia and New Zealand Council on Resuscitation [ANZCOR]); J.P. Nolan (Cochair, ILCOR); K. Okada (Japanese Resuscitation Council [JRC]); C. Reyes, MD (Latin American Resuscitation Council [CLAR]); M. Shuster, MD, FRCPC (Heart and Stroke Foundation of Canada [HSFC]); P.A. Steen, MD (ERC); M.H. Weil, MD, PhD (AHA); V. Wenzel (ERC). Also additional contributors: P. Carli (ERC), T.L. Vanden Hoek, MD (AHA, D. Atkins, MD (AHA).

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