Therapeutic hypothermia after cardiac arrest

Patients who are successfully resuscitated following cardiac arrest often present with what is now termed ‘post-resuscitation disease’ [1]. Most prominent, are post-resuscitation myocardial failure and ischemic brain damage. Although post-resuscitation myocardial dysfunction has been implicated as an important mechanism accounting for fatal outcomes after cardiac resuscitation [2–4], morbidity and mortality after successful cardiopulmonary resuscitation (CPR) largely also depends on recovery of neurologic function. As many as 30% of survivors of cardiac arrest in fact manifest permanent brain damage [5–7]. The greatest post-resuscitation emphasis has been on long-term neurologically intact survival [8]. Evidence favoring correction of electrolyte and glucose abnormalities, control of post-resuscitation cardiac rate, rhythm, systemic blood pressure, and intravascular volumes are cited but objective proof of these interventions is still anedoctal. Of all interventions, the most persuasive benefits have followed the use of hypothermia [8].