Abstract
Neurological recovery often determines outcome in patients resuscitated after cardiac
arrest. Temperature control as a neuroprotective strategy has become standard of care.
The first randomized trials showing improved neurological outcomes in patients treated
with hypothermia with a target temperature of 33°C over a decade ago led to the inclusion
of this intervention in practice guidelines and the broad adoption of hypothermia
protocols across the world. More recently, large randomized trials showed no difference
from targeting a temperature of 33 or 36°C and no benefit from pre-hospital induction
of hypothermia. Temperature control remains a crucial part of post–cardiac arrest
care. However, the optimal temperature target, timing of induction, duration of temperature
control, and speed of rewarming are unclear. Similarly, the value of targeted temperature
management in cases of in-hospital arrest and non-shockable rhythms is unknown. This
article reviews the neuroprotective mechanisms of hypothermia, the evidence supporting
targeted temperature management after cardiac resuscitation, areas of persistent uncertainty
and controversy, and future research directions.
Keywords
cardiac arrest - resuscitation - therapeutic hypothermia - temperature control - outcomes
- neurological
