For comatose adult survivors of out-of-hospital cardiac arrest (OHCA), controlling body temperature to < 37.5 °C is a "reasonable and evidence-based approach," a new American Heart Association (AHA) scientific advisory suggests.
On the basis of data from recent trials, the International Liaison Committee on Resuscitation and other organizations have altered their treatment recommendations for temperature management after cardiac arrest.
The AHA will present guidelines on this topic in a focused update to be published later in the year. Meanwhile, AHA's Emergency Cardiovascular Care Committee convened a writing group to review the Hypothermia Versus Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial in the context of other recent evidence and rendered an expert opinion on how the trial may influence clinical practice. These findings will be incorporated into the upcoming guidelines.
"Many centers have already moved toward controlled normothermia for post-arrest patients, so we think this guidance will be welcomed by many," said Sarah Perman, MD, of the Yale School of Medicine, and Kate Berg, MD, of Beth Israel Deaconess Medical Center, who are both members of the AHA Emergency Cardiovascular Care Committee that authored the advisory.
"For those who continue to favor temperatures in the 32-36 ° range for some or even all patients, the guidance that we have drafted leaves room for clinicians to make patient-centered decisions," they told theheart.org | Medscape Cardiology.
"Certainly, a finite guideline that recommends one temperature for all would be easier to apply," the authors acknowledge. "However, cardiac arrest is a heterogeneous event and brain injury is variable, and definitive evidence that one temperature in the range of 32-37.5 is superior to another is lacking. We hope that clinicians find that this guidance supports and informs their practice."
SOURCE: Marilynn Larkin, Medscape Cardiology