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Hypothermia Case Review

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The American Heart Association (AHA) updated the 2005 cardiopulmonary resuscitation clinical practice guidelines after the New England Journal of Medicine published two landmark studies in 2002. The HACA and the Bernard, et al. study found significant improvement in neurological outcomes with therapeutic hypothermia. Additionally, the Bernard, et al. study also revealed reduced mortality after cardiac-arrest survivors received therapeutic hypothermia (2002). In 2010, the AHA strengthened its position based on the growing body of research. Therapeutic hypothermia was the only intervention shown to improve neurological outcomes (Peberdy, et al., 2010). The most updated guidelines, set by the AHA in 2015, recommended that all comatose,…show more content…
The researchers determined that further investigation is still needed, especially in regards to length of cooling and rewarming rates. There were multiple limitations to this study. The patient in the 34°C group had poorer prognostic factors, fewer resuscitation attempts, longer time to ROSC, and worse Glasgow coma score (Lopez-de-Sa, et al., 2012). While data favored the 32°C group, one point of consideration is that, as a pilot study, their aim was not to change practice but offer a basis for future research (2012).
The second RCT, by Nielsen, et al. (2013), challenged the depth of TH needed for neurologic protection. The trial authors found no benefit of cooling unconscious OHCA patients to 33°C compared to cooling to 36°C at either hospital discharge or 180-day follow up. There was no harm established in cooling to 33°C, but none of the point estimates favored the 33°C group (Neilsen, et al., 2013). The TTM study was a landmark point in the TH literature. When it was published, the TTM study represented the largest study to date on the benefits of TH. It also provided insight into different TTM protocols. While the conclusions drawn were somewhat controversial at the time, the authors maintained that their study should not be interpreted to conclude that TH should be abandoned (Perchiazzi, et al., 2014).
Two observational studies were included in this synthesis. A Swedish observational retrospective cohort study, by
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