Clinical application of mild therapeutic hypothermia after cardiac arrest*

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Abstract
Postresuscitative mild hypothermia lowers mortality, reduces neurologic impairment after cardiac arrest, and is recommended by the International Liaison Committee on Resuscitation. The European Resuscitation Council Hypothermia After Cardiac Arrest Registry was founded to monitor implementation of therapeutic hypothermia, to observe feasibility of adherence to the guidelines, and to document the effects of hypothermic treatment in terms of complications and outcome. Cardiac arrest protocols, according to Utstein style, with additional protocols on cooling and rewarming procedures and possible adverse events are documented. Between March 2003 and June 2005, data on 650 patients from 19 sites within Europe were entered. Patients who had cardiac arrest with successful restoration of spontaneous circulation were studied. Of all patients, 462 (79%) received therapeutic hypothermia, 347 (59%) were cooled with an endovascular device, and 114 (19%) received other cooling methods such as ice packs, cooling blankets, and cold fluids. The median cooling rate was 1.1 degrees C per hour. Of all hypothermia patients, 15 (3%) had an episode of hemorrhage and 28 patients (6%) had at least one episode of arrhythmia within 7 days after cooling. There were no fatalities as a result of cooling. Therapeutic hypothermia is feasible and can be used safely and effectively outside a randomized clinical trial. The rate of adverse events was lower and the cooling rate was faster than in clinical trials published.