Determination of Neurologic Prognosis is unreliable before at least 72 hours after ROSC
Do not neuroprognosticate until 72 hours post rewarming.
Greatest benefit in out-of-hospital V-fib, though may help in other dysrhythmias
Two most likely mechanisms of action:
Reduces cerebral metabolism by 6-8% per degree C
Reduces oxygen free radical production and lipid peroxidation
Cooling to 32-34ºC in initial studies, current studies suggest 36ºC equally beneficial
Treatment should be initiated immediately after ROSC
Patient may be cooled concurrently with cardiac catheterization
Cooling should occur prior to CT scan if there is need for intracranial pathology workup
AHA recommends 12-24 hrs of cooling
NNT of ~6
Pediatrics
Two large RTCs for TH, one in out-of-hospital and another in in-hospital arrests<unk>  does not appear to provide a survival or improved neurological benefit
In both studies, no difference in survival, function at 12 months post-arrest, blood product use, infection rates
Do not neuroprognosticate until 72 hours post rewarming.
Reduces cerebral metabolism by 6-8% per degree C
Reduces oxygen free radical production and lipid peroxidation
Patient may be cooled concurrently with cardiac catheterization
Two large RTCs for TH, one in out-of-hospital and another in in-hospital arrests<unk>  does not appear to provide a survival or improved neurological benefit
In both studies, no difference in survival, function at 12 months post-arrest, blood product use, infection rates
In both studies, no difference in survival, function at 12 months post-arrest, blood product use, infection rates
Therapeutic hypothermia
Ventriculoperitoneal shunt drainage
ICU sedation
Extracorporeal membrane oxygenation
Traumatic asphyxia
Ventriculoperitoneal shunt obstruction
Advanced airway adjuncts
Neonatal resuscitation