Does temperature management improve outcome in patients resuscitated from a non-shockable rhythm?
Therapeutic hypothermia or targeted temperature management (TTM) has in the last 15 years been widely implemented (1) as a means to ameliorate the systemic inflammatory response often seen in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA), later defined as the post cardiac arrest syndrome (PCAS). The PCAS includes anoxic brain injury, myocardial dysfunction and systemic is chemia/reperfusion injuries caused by the arrest itself and/or the precipitating cause of the arrest (2). The treatment modality of TTM was introduced in humans by two prospective randomized trials from 2002 targeting a core temperature of 32–34 ℃ (3,4), including a combined total of 352 patients, finding favorable neurological outcome in patients treated with TTM. These studies included patients resuscitated from a shockable rhythm [ventricular tachycardia (VT) and/or ventricular fibrillation (VF)], whereas patients resuscitated from a nonshockable rhythm [pulseless electrical activity (PEA) and asystole] were not assessed for inclusion.