Dillemas in the use of therapeutic hypothermia after cardiac arrest

BACKGROUND Sudden cardiac death is a leading cause for mortality and severe disability worldwide. Survival following out of hospital cardiac arrest remains very low, in the range of 5-10%1 and many survivors are left with significant neurological impairment. Most patient who die after out of hospital cardiac arrest die as a direct consequence of the neurological insult.

Hypothermia has long been known to be associated with better outcome following drowning and was used to protect the brain during cardiac and brain surgery. In 2002 two pivotal trials were published which demonstrated the ability of mild therapeutic hypothermia (MTH) to improve survival and neurological outcome following out of hospital cardiac arrest2,3. Since then, MTH was recommended by the resuscitation guidelines and adopted in many centers. However, important questions remain concerning the use of this modality in real practice. Th is brief review highlights the main current dilemmas in the field.