Does the evidence support the use of mild hypothermia after cardiac arrest? Yes

doi:10.1136/bmj.d5830

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Jerry P Nolan, consultant in anaesthesia and intensive care medicine1,
Jasmeet Soar, consultant in anaesthesia and intensive care medicine2

¹Royal United Hospital NHS Trust, Bath BA2 7AJ, UK
²Southmead Hospital, North Bristol NHS Trust, Bristol, UK

Correspondence to: J P Nolan jerry.nolan{at}nhs.net

Several guidelines recommend hypothermia for comatose patients who have had a cardiac arrest outside hospital. Jerry Nolan and Jasmeet Soar believe the data support this advice, but Andrew Walden, Niklas Nielsen, and Matt Wise (doi:10.1136/bmj.d5889) question the quality of the evidence

The use of mild hypothermia in comatose survivors of cardiac arrest has been shown to improve neurological outcome in both animals and humans.1 2 The evidence of benefit is strongest for people who have had a ventricular fibrillation cardiac arrest outside hospital, but data are beginning to emerge supporting its use in other types of arrest.

Supportive evidence

A randomised trial3 and a pseudorandomised (by day of the month) trial4 of cooling unconscious patients to 32-34ºC after ventricular fibrillation cardiac arrest outside hospital both recorded benefits.3 4 The randomised Hypothermia After Cardiac Arrest (HACA) study enrolled 275 patients (8% of those assessed).3 Those in the hypothermia group were sedated, paralysed, ventilated, and surface cooled to 32-34°C for 24 hours. Seventy five (55%) of the 136 in the hypothermia group showed a favourable neurological outcome at 6 months compared with 54 (39%) of 137 in the normothermia …