Therapeutic hypothermia following cardiac arrest: a review of the evidence

Tim J Collins, Peter J Samworth
Nursing in Critical Care 2008, 13 (3): 144-51

AIMS AND OBJECTIVES: This paper aims to undertake a review on the current evidence available on therapeutic hypothermia (TH) following cardiac arrest.

BACKGROUND: The use of TH has been associated as a potential treatment for a number of medical conditions including head injury and cerebral vascular accidents. Within the past decade, there have been numerous studies focusing upon the use of hypothermia following cardiac arrest. This paper evaluates the research on the use of TH following cardiac arrest and provides recommendations for clinical practice. Evidence from randomized controlled trials that are reviewed in this paper found that neurological outcome and mortality were significantly improved following inducing hypothermia following cardiac arrest.

SEARCH STRATEGIES: The following databases were accessed: Bandolier, Embase, Medline, Science Direct, CINAHL, Blackwell Synergy, Nursing Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the National Electronic Library for Health. The following key words were used to search the databases: 'Therapeutic hypothermia', 'Induced hypothermia', 'cooling post cardiac arrest' and 'post cardiac arrest care'.

INCLUSION AND EXCLUSION CRITERIA: Only evidences published within the past 10 years and written in English were included. Studies on TH for the treatment of raised intracranial pressure were excluded.

CONCLUSIONS: All adult patients who have return of spontaneous circulation and remain unconscious following cardiac arrest should be considered for TH between 32 degrees C and 34 degrees C for at least 12-24 h as this will improve patient mortality and morbidity. Acute hospitals need to devise policies and guidelines on the use of TH following cardiac arrest that include methods on how to achieve effective cooling by cold i.v. infusions, ice packs or purchasing specific cooling mattresses.

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