Hypothermia after cardiac arrest

Lowering the temperature decreases cerebral metabolic rate, which brings oxygen demand closer to oxygen supply. This is important not only during cardiac arrest and CPR, but also during first hours after return of spontaneous circulation (ROSC), when certain areas of the brain are clearly hypoperfused. We compared our patients treated with MIH (hypothermic group, n=89) with the consecutive patients with same inclusion criteria treated in our Department before January 2004 (normothermic group, n=70). Six months after arrest 60% were alive in the hypothermic group compared to 40% in the normothermic group (p=0.043). Good neurologic recovery (CPC 1 or 2) was achieved in 51% vs. 30%, respectively, (p=0.022), and best neurologic recovery (CPC 1) was achieved in 41% vs. 14%, respectively, (p=0.001). Number needed to treat (NNT) to save one additional life (or to have one additional good recovery) was 5. We can conclude that mild induced hypothermia improves survival and neurologic recovery in patients resuscitated from cardiac arrest of presumed cardiac origin. Therefore, we strongly promote prehospital initiation of cooling.