Recent developments and controversies in therapeutic hypothermia after cardiopulmonary resuscitation - 13/01/23

Doi : 10.1016/j.ajem.2022.11.002

Peijuan Li ^a,^e,^{^{1
Peijuan Li and Zhangping Sun have contributed equally as the First authors.}}, Zhangping Sun ^a,^e,^{^{1
Peijuan Li and Zhangping Sun have contributed equally as the First authors.}}, Tian Tian ^a,^e, Dongping Yu ^b, Hui Tian ^c, Ping Gong ^d,^a,^{^⁎}
^a Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
^b Department of Emergency, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
^c Department of Emergency, Dalian Municipal Central Hospital, Dalian, Liaoning, China
^d Department of Emergency, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
^e Dalian Medical University, Dalian, Liaoning, China

^⁎Corresponding author at: Department of Emergency, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), No. 1017 Dongmen North Road, Shenzhen 518020, Guangdong, China.Department of EmergencyShenzhen People's Hospital (The Second Clinical Medical College, Jinan UniversityThe First Affiliated Hospital, Southern University of Science and Technology)No. 1017 Dongmen North RoadShenzhenGuangdong518020China

Abstract

Therapeutic hypothermia was recommended as the only neuroprotective treatment in comatose patients after return of spontaneous circulation (ROSC). With new evidence suggesting a similar neuroprotective effect of 36 °C and 33 °C, the term “therapeutic hypothermia” was substituted by “targeted temperature management” in 2011, which in turn was replaced by the term “temperature control” in 2022 because of new evidence of the similar effects of target normothermia and 33 °C. However, there is no clear consensus on the efficacy of therapeutic hypothermia. In this article, we provide an overview of the recent evidence from basic and clinical research related to therapeutic hypothermia and re-evaluate its application as a post-ROSC neuroprotective intervention in clinical settings.

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Keywords : Cardiopulmonary resuscitation, Return of spontaneous circulation, Therapeutic hypothermia, Targeted temperature management, Temperature control

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Introduction

Basic research on TH

Clinical research on TH

Main evidence supporting the benefits of TH

Main evidence that does not support the benefits of TH

Difficulties in the transformation of TH from basic research to clinical practice

Heterogeneity of CA patients

Differences between animal models and CA patients

Common problems in clinical trials

Selection bias in clinical studies

Temperature management in the control group may affect the results of clinical trials

Delayed and slow cooling in the clinical trials

Other factors affecting the results of clinical trials

New thinking triggered by new evidence from TH research

Conclusion and perspective

Authors' contributions

Funding

CRediT authorship contribution statement

Esportazione

Vol 64

P. 1-7 - febbraio 2023 Ritorno al numero

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Recent developments and controversies in therapeutic hypothermia after cardiopulmonary resuscitation - 13/01/23

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