Indications and Contraindications for Targeted Temperature Management in Comatose Patients after Cardiac Arrest

Targeted temperature management should be implemented in the context of a broader strategy of critical care for a comatose patient with the post-cardiac arrest syndrome.

Indications and Contraindications for Targeted Temperature Management in Comatose Patients after Cardiac Arrest.
Patients for whom therapeutic hypothermia should be considered
  • Adult patients successfully resuscitated from a witnessed out-of-hospital cardiac arrest of presumed cardiac cause (patients after in-hospital cardiac arrest may also benefit)
  • Patients who are comatose (i.e., patients with a score on the Glasgow Coma Scale of less than 8 or patients who do not obey any verbal command at any time after restoration of spontaneous circulation and before initiation of cooling)
  • Patients with an initial rhythm of ventricular fibrillation or nonperfusing ventricular tachycardia (patients presenting with other initial rhythms such as asystole or pulseless electrical activity may also benefit)
  • Patients whose condition is hemodynamically stable (retrospective data suggest that patients in cardiogenic shock may also safely undergo hypothermia treatment)
Patients for whom therapeutic hypothermia should not be considered
  • Patients with tympanic-membrane temperature below 30°C on admission
  • Patients who were comatose before the cardiac arrest
  • Pregnant patients
  • Patients who are terminally ill or for whom intensive care does not seem to be appropriate
  • Patients with inherited blood coagulation disorders
References:
  1. Holzer M. Targeted temperature management for comatose survivors of cardiac arrest. N Engl J Med. 2010 Sep 23;363(13):1256-64. [Medline]
  2. Arrich J; European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group. Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med. 2007 Apr;35(4):1041-7. [Medline]
Created: Sep 28, 2010