Targeted Therapeutic Hypothermia After Cardiac Arrest

Abstract

Background: Cardiac arrest (CA), a significant cause of death worldwide, is characterised by high mortality rates and poor neurological outcomes. Despite advancements in resuscitation strategies, achieving survival with optimal neurological outcomes is still a challenge. Therapeutic hypothermia (TH) has emerged as a potential approach in post-CA care to enhance outcomes and minimise neurological damage. Thus, this dissertation aimed to evaluate the impact of TH on survival with favourable neurological outcomes at hospital discharge in adults following successful resuscitation. Method: A systematic literature search was performed across three electronic databases (Medline, Embase and the Cochrane Central Register of Controlled Trials) for data published until 27th of May 2023. Eligibility criteria included randomised controlled trials (RCTs) comparing TH with normothermia in post-CA adult patients. Then, all included studies were screened against predefined criteria, as well as assessed utilising the Critical Appraisal Skills Programme (CASP) tool to evaluate their quality. Results: Of the initial 1,052 articles screened, 424 duplicates were removed, whereas subsequent title and abstract screening excluded an additional 600, leaving 28 for full-text review. Of these, only six RCTs met the predefined inclusion criteria. Based on these included studies, the efficacy of TH as a neuroprotective strategy after successful resuscitation, specifically targeting survival with favourable neurological outcomes, remains undetermined. The included studies yielded mixed results and exhibit notable limitations. Conclusion: The evidence of TH efficacy in enhancing survival with favourable neurological outcomes remains inconclusive. As such, future rigorous, large-scale RCTs emphasising fever prevention strategies are essential to determine conclusively the role of TH in post-resuscitation care.