Improved Prognosis After Using Mild Hypothermia to Treat Cardiorespiratory Arrest Due to a Cardiac Cause: Comparison With a Control Group

Part 9: Post–Cardiac Arrest Care

“…Additional studies with historical control groups show improved neurological outcome after therapeutic hypothermia for comatose survivors of VF cardiac arrest. 20,21 No randomized controlled trials have compared outcome between hypothermia and normothermia for non-VF arrest. However, 6 studies with historical control groups reported a beneficial effect on outcome from use of therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest associated with any arrest rhythm.…”

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

“…157,158 Additional studies with historical control groups also have shown improved neurological outcomes after therapeutic hypothermia for comatose survivors of VF arrest. 194,195 Accordingly, therapeutic hypothermia should be initiated in patients with STEMI and out-of-hospital cardiac arrest. Cooling should begin before or at the time of cardiac catheterization.…”

Part 8: Advanced Life Support

“…Two studies with historical control groups (LOE 3) showed improvement in neurological outcome after therapeutic hypothermia for comatose survivors of VF cardiac arrest. 824,825 One systematic review demonstrated that conventional cooling methods were more likely to reach a best cerebral performance category score of 1 or 2 (5-point scale where 1 is good and 5 is brain death) with a relative risk of 1.55 (99.5% CI 1.22 to 1.96) and more likely to survive to hospital discharge (relative risk of 1.35 95% CI 1.1 to 1.65) compared with standard postresuscitation care (LOE 1). 826 One small (nϭ30) randomized trial showed reduced plasma lactate values and oxygen extraction ratios in a group (nϭ16) of comatose survivors after cardiac arrest with asystole or PEA who were cooled with a cooling cap (LOE 1).…”

“…(See also Implementing Therapeutic Hypothermia in Section 12). Nineteen studies indicated that cooling could be initiated safely with IV ice-cold fluids (30 mL/kg of saline 0.9% or Ringer's lactate) (LOE 3 748,749,825,831,833,837 ; LOE 4 779,780,782-785,810,836,838 -843 ). Six studies indicated that cooling with IV cold saline can be initiated in the prehospital phase (LOE 1 781,844 ; LOE 2 845 ; LOE 3 261,846 748,841,850,[853][854][855].…”