title: Therapeutic hypothermia in the intensive cardiac care unit.
abstract: Therapeutic hypothermia has demonstrated to improve both survival and neurological outcome in patients who experienced an out-of-hospital cardiac arrest. Nevertheless, many aspects of its clinical application are still controversial. Current guidelines recommend to cool patients who survive a cardiac arrest due to either ventricular fibrillation or ventricular tachycardia, whereas the beneficial effect of lowering body temperature in nonshockable rhythms is still questionable due to the lack of randomized controlled trial involving this subgroup of patients. Although therapeutic hypothermia is often begun before hospital arrival, the optimal time to start cooling is still a matter of debate. Furthermore, different methods are available to low body temperature, but no direct comparisons are available to establish which device performs better than others, and a combination of external and endovascular cooling is usually preferred. The present review is aimed at summarizing the available evidence supporting the use in clinical practice of mild hypothermia in comatose survivors from cardiac arrest and at evaluating its adverse events and their treatment.
authors.affiliation: aDepartment of Cardiology, Misericordia Hospital, Grosseto bDepartment of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Picchi
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Gensini
mesh_terms: D000818:Animals; D002300:Cardiac Care Facilities; D000075202:Contraindications; D004195:Disease Models, Animal; D004565:Electroconvulsive Therapy; D019317:Evidence-Based Medicine / Q000379:methods; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D007362:Intensive Care Units; D000066829:Neuroprotection / Q000502:physiology