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Therapeutic hypothermia benefits assessed

Therapeutic hypothermia can be used to improve the outcomes of shockable (ventricular fibrillation or pulseless ventricular tachycardia [VF/VT]) cardiac arrest patients, but has no significant impact on the outcome of nonshockable (pulseless electric activity or asystole [PEA/asystole]) patients, according to a study(1) recently published in Circulation.

The study assessed the prognostic value of hypothermia for neurological outcome at hospital discharge according to first-recorded cardiac rhythm in a large cohort. Data were amassed from 1,145 consecutive out-of-hospital cardiac arrest patients in whom a successful resuscitation had been achieved, between January 2000 and December 2009.

cooling-stroke-2After adjustment for other factors, in VF/VT patients, hypothermia was associated with increased odds of good neurological outcome (adjusted odds ratio, 1.90; 95% confidence interval, 1.18 to 3.06) but not in PEA/asystole patients (adjusted odds ratio, 0.71; 95% confidence interval, 0.37 to 1.36). The study’s authors recommend further investigation into the implications of this discrepancy.

While therapeutic hypothermia has been shown to considerably improve outcomes for patients at risk of ischaemic tissue damage, a drawback of the technique is that it provokes the body’s natural response to potentially dangerous reduction in temperature. Shivering, a defense mechanism against cooling, produces more body heat and increases overall metabolic activity, dramatically increasing oxygen demand and consumption.

This can have deleterious effects for patients who have suffered a global ischaemic event. In order to overcome this increase in metabolic heat the physician must usually paralyze a patient to eliminate shivering, unless the cooling system is specifically designed to quickly get below the shivering threshold.

Advancement in the therapeutic uses of induced hypothermia were the focus of an announcement published recently in the International Journal of Stroke. The report outlines the findings and objectives laid out by the European Hypothermia Stroke Research Workshop, held in January 2010, which was organised by the European Stroke Research Network for Hypothermia (EuroHyp) and attended by representatives of the World Stroke Organisation, European Stroke Organisation, and the European Space Agency.

We will feature more news and reviews on therapeutic hypothermia in the future.


  1. Dumas F, Grimaldi D, ZuberIs B et al. Hypothermia After Cardiac Arrest Effective in Both Shockable and Nonshockable Patients? Insights From a Large Registry. Circulation 2011, doi: 10.1161/CIRCULATIONAHA.110.987347
  2. Macleod MR, Petersson J, Norrving B et al. Hypothermia for Stroke: call to action 2010. International Journal of Stroke 2010;5:489–92

Published on: March 3, 2011

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