Prehospital use of therapeutic hypothermia after resuscitation from cardiac arrest.
The use of therapeutic hypothermia (TH) in the care of patients after resuscitation from sudden cardiac arrest (SCA) has been shown to improve both survival and neurologic outcomes in randomized, controlled trials and a growing number of cohort studies with historical controls. The robust nature of the data supporting postarrest TH is reflected in the wide variety of clinical investigations that have confirmed outcome benefits of similar magnitude. A number of important questions remain surrounding the implementation of postarrest TH, including the timing of cooling induction and how rapidly providers need to initiate cooling therapy. Several investigations have suggested that earlier cooling may maximize the benefit from TH and that, conversely, increasing delays to TH induction may lead to worse patient outcomes. Prehospital initiation of TH has been proposed as a means to address time barriers inherent in out-of-hospital SCA. In this paradigm, emergency medical service (EMS) personnel are able to start cooling therapies immediately after resuscitation, which can then be continued during transport. Newer technologies may provide other opportunities for rapid cooling in the field; however, the risks and benefits of prehospital cooling remain poorly understood. This review will describe the growing literature and future directions pertaining to prehospital induction of TH after SCA.
Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania.
Marion
M
Leary
Florence
F
Vanek
Benjamin S
BS
Abella