Therapeutic Hypothermia in Comatose Patients after Cardiac Arrest

Targeted Temperature Management for Comatose Survivors of Cardiac Arrest

N Engl J Med 2010;363:1256-64.

Indications

• Adult patients successfully resuscitated from a witnessed OHCA of presumed cardiac cause (patients after in-hospital cardiac arrest may also benefit)
• Patients who are comatose (i.e., patients with GCS < 8 or patients who do not obey any verbal command at any time after ROSC and before initiation of cooling)
• Patients with an initial rhythm of Vf or nonperfusing VT (patients presenting with other initial rhythms such as asystole or PEA may also benefit)
• Patients whose condition is hemodynamically stable (retrospective data suggest that patients in cardiogenic shock may also safely undergo hypothermia treatment)

Contraindications

• Patients with tympanic-membrane temperature below 30°C on admission
• Patients who were comatose before the cardiac arrest
• Pregnant patients
• Patients who are terminally ill or for whom intensive care does not seem to be appropriate
• Patients with inherited blood coagulation disorders

Adverse Events 

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