Temperature management after cardiac arrest an advisory statement by the advanced life support task force of the international liaison committee on resuscitation and the American Heart Association emergency cardiovascular care committee and the council on cardiopulmonary, critical care, perioperative and resuscitation

Lars W. Andersen, Katherine M. Berg, Clifton W. Callaway, Michael N. Cocchi, Michael W. Donnino, Eddy Lang, Joshua C. Reynolds, Peter T. Morley, Jerry P. Nolan, Jasmeet Soar, Theodoros Xanthos

Research output: Contribution to journalArticle (Academic Journal)peer-review

113 Citations (Scopus)

Abstract

For more than a decade, mild induced hypothermia (32°C-34°C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33°C or 36°C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32°C and 36°C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.

Original languageEnglish
Pages (from-to)2448-2456
Number of pages9
JournalCirculation
Volume132
Issue number25
DOIs
Publication statusPublished - 2015

Bibliographical note

Funding Information:
Besides the authors (Drs Donnino, Callaway, Soar, and Nolan), members of the ILCOR ALS Task Force include Mayuki Aibiki, Bernd W. Böttiger, Steven C. Brooks, Charles D. Deakin, Saul Drajer, Walter Kloeck, Laurie J. Morrison, Robert W. Neumar, Tonia C. Nicholson, Brian J. O’Neil, Edison F. Paiva, Michael Parr, Tzong-Luen Wang, and Jonathan Witt. We would like to acknowledge Christine Neilson and the team at St. Michael's Hospital in Toronto for their literature searches. Disclosures Writing Group Disclosures. Writing Group Member Employment Research Grant Other Research Support Speakers’ Bureau/Honoraria Expert Witness Ownership Interest Consultant/Advisory Board Other Lars W. Andersen Beth Israel Deaconess Medical Center None None None None None None None Katherine M. Berg Beth Israel Deaconess Medical Center None None None None None None None Clifton W. Callaway University of Pittsburgh None None None None None None None Michael N. Cocchi Beth Israel Deaconess Medical Center None None None None None None None Michael W. Donnino Beth Israel Deaconess Medical Center None None None None None AHA † None Eddy Lang University of Calgary Emergency Medicine None None None None None AHA † University of Calgary † Peter T. Morley University of Melbourne Clinical School None None None None None AHA † None Jerry P. Nolan Royal United Hospital, Bath NIHR * None None None None None None Joshua C. Reynolds Michigan State University College of Human Medicine None None None None None None None Jasmeet Soar Southmead Hospital Department of Anesthesia and Intensive Care None None None None None None None Theodoros Xanthos Midwestern University of Chicago College of Pharmacy None None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person's gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. * Modest. † Significant. Reviewer Disclosures. Reviewer Employment Research Grant Other Research Support Speakers’ Bureau/Honoraria Expert Witness Ownership Interest Consultant/Advisory Board Other Niklas Nielsen Helsingborg Hospital (Sweden) Swedish Heart and Lung Foundation † ; AFA Insurance Foundation † ; Swedish Research Council † None Bard Medical * None None None None Gavin Perkins Warwick Medical School and Heart of England NHS Foundation Trust (UK) Funding from National Institute for Health Research † None None None None None None Kjetil Sunde University of Oslo (Norway) None None Bard Medical * None None None None This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person's gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. * Modest. † Significant. Appendix A

Publisher Copyright:
© 2015 by the American Heart Association, Inc., and the European Resuscitation Council.

Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.

Keywords

  • AHA scientific statements
  • Cardiac arrest
  • Duration
  • Heart arrest
  • Hypothermia
  • Resuscitation
  • Temperature management
  • Timing

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