Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest - A clinical feasibility trial

Background and Purpose-Recent animal studies showed that mild resuscitative hypothermia improves neurological outcome when applied after cardiac arres t. Tn a 3-year randomized, prospective, multicenter clinical trial, we hypo thesized that mild resuscitative cerebral hypothermia (32 degrees C to 34 d egrees C core temperature) would improve neurological outcome after cardiac arrest. Methods-We lowered patients' temperature after admission to the:emergency d epartment and continued cooling for at least 24 hours after arrest in conju nction with advanced cardiac life support. The cooling technique chosen was external head and total body cooling with a cooling device in conjunction with a blanket and a mattress, Infrared tympanic thermometry was monitored before a central pulmonary artery thermistor probe was inserted. Results-In 27 patients (age 58 [interquartile range [IQR] 52 to 64] years; a women; estimated "no-flow" duration 6 [IQR 1 to 11] minutes and "low-flow " duration 15 [IQR 9 to 23] minutes; admitted to the emergency department 3 6 [IQR 24 to 43] minutes after return of spontaneous circulation), we could initiate cooling within 62 (IQR 41 to 75) minutes and achieve a pulmonary artery temperature of 33+/-1 degrees C 287 (IQR 42 to 401) minutes after ca rdiac arrest. During 24 hours of mild resuscitative hypothermia, no major c omplications occurred. Passive rewarming >35 degrees C was accomplished wit hin 7 hours. Conclusions-Mild resuscitative hypothermia in patients is feasible and safe . A clinical multicenter trial might prove that mild hypothermia is a usefu l method of cerebral resuscitation after global ischemic states.