Matthias Derwall1, Michael Fries2, Rolf Rossaint1
1Department of Anesthesiology and 2Department of Surgical Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
[Applied Cardiopulmonary Pathophysiology 16: 202-211, 2012]
Permanent neurocognitive deficits due to cerebral sequelae account for the majority of long-term morbidity and mortality in survivors of cardiac arrest today.
Albeit therapeutic hypothermia had been used as effective measure to ameliorate cerebral ischemia-reperfusion injury during surgery for decades, it was not yet introduced into regular post-arrest care until 2003 due to significant side effects of profound hypothermia. These include shivering, higher infection rates, coagulopathy or cardiac arrhythmias, but are less frequently observed with mild therapeutic hypothermia. When body temperature is kept around 33°C, the beneficial effects of hypothermia clearly outweigh its adverse effects. Therefore, treatment of comatose survivors of out-of-hospital cardiac arrest using mild therapeutic hypothermia has now been widely adopted around the globe. Although it still remains controversial who, how, when, and for how long to cool, with only six patients requiring treatment to save one additional life, it is clear that therapeutic hypothermia is the single most effective intervention in brain resuscitation available today.
Key words: cardiac arrest, cardiopulmonary resuscitation, cerebral ischemia, induced hypothermia
Matthias Derwall, M.D.
Klinik für Anästhesiologie
Universitätsklinikum der RWTH Aachen