Therapeutic Cooling of Patients with Arrest After Nonshockable Rhythms

Early studies of out-of-hospital arrest after a shockable rhythm (i.e., ventricular tachycardia or fibrillation) demonstrated benefit for therapeutic temperature management (TTM). Subsequent investigations have yielded mixed results, and meta-analyses have demonstrated benefit, harm, or no effect of TTM. The population for which we have the least guidance are those who have arrest with nonshockable rhythm (i.e., pulseless electrical activity [PEA] or asystole).

French investigators randomized 581 patients after resuscitation with nonshockable rhythm to either 24 hours of hypothermia (active cooling to 33°C with gradual rewarming) or 48 hours of normothermia (maintenance of 36.5–37.5°C). Three quarters of patients had out-of-hospital arrest; …