Cardiac Arrest and Mild Therapeutic Hypothermia

Mild therapeutic hypothermia (MTH) has become widely accepted after cardiopulmonary resuscitation (CPR) to date. MTH should be induced as soon as possible. First reports recommend the induction already during CPR (Pre-ROSC). This very early induction seems of more benefit in terms of neurologic recovery. But, MTH may act in a delayed post-reperfusion window too. Though a number of details are not fully understood the current recommendation for MTH in CPR patients include cooling independent from initial heart rhythm, as soon as possible to 34-32 degrees C for 12-24 hours and a slow rewarming. Induction of MTH should be done with simple methods with high efficiency. After stabilisation of the patients, a feedback temperature-controlled endovascular or transcutaneous device for maintenance should be applied. MTH is accompanied by "device-associated" and "method-specific" side effects. Severe side effects are generally rare, but have to be considered to avoid an impairment of the individual outcome. A prognostication of neurologic outcome after MTH in CPR patients should carefully be done at the earliest three days after resuscitation. The interpretation has to consider several prognostic parameters. A reevaluation at day seven is indispensable.