Hypothermia Therapy in Sudden Death

Therapeutic hypothermia has been used for millennia, but more recently, targeted temperature management has caught physician’s interest as the main neuroprotective strategy for cardiac arrest patients who remain comatose after return of spontaneous circulation. Randomized clinical trials have shown benefits in neurologic and mortality outcomes when lowering body’s core temperature to mild-to-moderate ranges of hypothermia, in conjunction with strict hyperthermia prevention measurements. The International Liaison Committee on Resuscitation recommends in their current guidelines to use a target temperature between 32 °C and 36 °C, for at least 24 h, in post-cardiac arrest patients, regardless of their initial rhythm (shockable vs. non-shockable). Therapeutic hypothermia consists of three well-defined phases: induction, maintenance, and rewarming. Each of these phases has very specific physiologic and clinical considerations for optimal patient management. The optimal dose, the induction and maintenance method, and the temperature monitoring technique remain unclear and are the focus of future research. Despite the overwhelmingly positive data regarding the benefits of therapeutic hypothermia, this technique remains underused. Clinicians should be familiar with this therapeutic intervention.