Does the evidence support the use of mild hypothermia after cardiac arrest? YesBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5830 (Published 23 September 2011) Cite this as: BMJ 2011;343:d5830
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We read this head to head debate with great interest and wish to
share our experience. Nine critical care units in the North West of
England recently submitted data on 101 patients admitted to critical care
post cardiac arrest, a project under the auspices of the Association of
North West Intensive Care Units. Our primary aim was to study our cooling
and rewarming processes post cardiac arrest and secondarily to obtain
survival data and neurological outcomes at hospital discharge.
We showed that therapeutic hypothermia can be implemented effectively
across a range of units in the UK, in routine clinical settings and with
different methods of temperature management. We were able to demonstrate
the effectiveness of our cooling and rewarming processes, with our data
being comparable to that obtained in randomised trials1,2 and meeting
guidelines set by the International Liaison Committee for Resuscitation3
(ILCOR). In addition our outcome data is encouraging and similar to that
obtained in previous trials1,2 with 53% survival to hospital discharge
post VF arrest. All survivors were discharged from hospital with either
good neurological recovery or moderate disability but able to function
Neurological injury is responsible for much of the subsequent
morbidity and mortality amongst initial survivors of cardiac arrest and we
as clinicians should do our utmost to try and prevent this. Despite an
increasing evidence base, a significant minority of clinicians within the
UK remain sceptical to the benefits of therapeutic hypothermia post
cardiac arrest. Indeed even when used as a therapeutic option, its use is
sometimes half hearted and often delayed4. In our opinion the benefits of
therapeutic hypothermia in the majority, considerably outweigh its
potential harm and this valuable treatment option should continue to be
used effectively when indicated.
A UK specific national registry, using a template similar to ours,
would perhaps help inform best practice on the use of this valuable
treatment option and allow the continued development of standards for use
in the prehospital, emergency department and critical care setting.
1. Bernard S, Gray T, Buist M et al. Treatment of comatose survivors
of out-of-hospital cardiac arrest with induced hypothermia. New England
Journal of Medicine 2002; 346(8): 557-563.
2. The Hypothermia After Cardiac Arrest Study Group. Mild therapeutic
hypothermia to improve the neurologic outcome after cardiac arrest. New
England Journal of Medicine 2002; 346(8): 549-556.
3. Nolan J, Morley P, Vanden Hoek T et al. Therapeutic hypothermia
after cardiac arrest. An advisory statement by the Advanced Life
Support Task Force of the International Liaison Committee on
Resuscitation. Resuscitation, 2003; 57:231-235.
4. Galloway R, Sherren P. Therapeutic hypothermia following out-of-
hospital cardiac arrest; does it start in the emergency department?
Emerg Med J 2010;27:948-949.
Competing interests: No competing interests