Targeted Temperature Management after Cardiac Arrest (original) (raw)

2014, New England Journal of Medicine

coauthors (Dec. 5 issue) 1 show the importance of avoiding hyperthermia in patients who have had a cardiac arrest. However, if the clinical objective is to improve the neurologic outcome, it is important to define the expected neurologic outcome in individual patients. Studies have shown that the severity of neuronal lesions is dependent on the delay in initiation of cooling after reperfusion. 2 In the article by Nielsen et al., the studied patients had a median return of spontaneous circulation of 25 minutes, with a wide interquartile range of 18 to 40 in the hypothermic group and 16 to 40 in the normothermic group. In prolonged cardiac arrest, we do not expect that a reduction of neurologic metabolism by hypothermia will have a real effect on already damaged structures. We should not conclude, on the basis of this trial, that hypothermia is simply an antihyperthermic strategy. Not all cardiac arrests are equal in terms of the time to return of spontaneous circulation. We should identify the subgroups of patients who can benefit from this form of therapy.