Understanding temperature goals after cardiac arrest

Excerpt

The incidence of treated out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause is 15–149 per 100,000 person-years with survival rates to hospital discharge between 1 and 31% [1]. Early deaths are most commonly caused by refractory circulatory shock while delayed deaths, which represent roughly two-thirds of total mortality, relate to devastating neurological injury [2]. The outcomes following OHCA are improving with only 10% of survivors at hospital discharge having neurological sequelae that make assistance necessary with activities of daily living [3], although the incidence of subtle cognitive dysfunction is two to three times higher [4]. The interest in hypothermic targeted temperature management (TTM) to influence both survival and neurological outcomes following OHCA was spurred by two landmark publications in 2002, and the application of TTM has since generated close to 1000 publications in PubMed (as of 1 February 2017). Although the optimal target temperature remains unclear, TTM remains an important feature of post-resuscitation care and is recommended in the joint European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care [5]. Many aspects of TTM in OHCA deserve further clinical investigation as highlighted in this short summary. …