The 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care have incorporated new recommendations for the application of therapeutic hypothermia in the post resuscitation period. External cooling applied to comatose patients upon return of spontaneous circulation (ROSC) who are hemodynamically stable results in increased survival and better neurologic outcomes. Out of hospital cardiac arrest in which the initial rhythm was VF carries a Class IIa recommendation. In hospital cardiac arrest and out of hospital non VF arrest carry a IIb recommendation.
There are details to attend to in real world implementation of the recommendations. Patient selection is difficult, and many patients will not be candidates. This concise review in CMAJ covers some of the practical aspects such as cooling methods, temperature goals, patient selection and complications.
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