Body Cooling Recommended for Some Comatose Patients After Cardiac Arrest

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

The American Academy of Neurology has issued new guidelines aimed at reducing brain injury in patients who are comatose after cardiopulmonary resuscitation.

Among the recommendations for patients after return of spontaneous circulation after out-of-hospital cardiac arrest:

• When the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF), therapeutic hypothermia (32–34 degrees C for 24 hours) should be offered. Evidence indicates that such treatment likely improves functional neurologic outcome and survival.

• When the initial cardiac rhythm is either VT/VF or asystole/pulseless electrical activity, targeted temperature management is likely as effective as therapeutic hypothermia and may be used instead. With this strategy, body temperature is lowered slightly and then gradually rewarmed and held below 37.5 degrees C over 72 hours.

• Prehospital cooling as an adjunct to therapeutic hypothermia should not be offered, as it likely offers no additional benefit.

The guidelines appear in Neurology.