Therapeutic hypothermia: pitfalls and pearls

Background and goal

Mild therapeutic hypothermia (MH) improves neurological recovery after prehospital cardiac arrest (OHCA) [1] and has become a standard procedure in post-resuscitative care. Our goal was to study the complications during MIH [2].

Materials and methods

We evaluated retrospectively 30 patients after VF-OHCA with regard to complications associated with the use of MIH. MIH was induced by use of a surface cooling protocol and maintained for 12–24 hours. Incidence of koagulopathy, electrolyte disorders, pneumonia (within 72 hours after admission), leukopenia, pancreatitis, hemorrhage, elevated amylase and arrhythmias requiring treatment were documented.

Results and discussion

The median age of the patients was 60.5 years (32–75 years), with all patients (100%) having presumed cardiac cause of OHCA and ventricular fibrillation/pulsless ventricular tachykardia (VF/VT) as the initial ECG rhythm. All patients were intubated at the scene. The presenting arrhythmias during MIH were VF in one patient, VT in two patients and rapid atrial fibrillation in four patients.

Conclusion

MIH is a safe therapy when the clinician is aware of the potential side effects. Electrolyte disorders during MIH and pneumonia after MIH treatment should be anticipated and treated pre-emptively.

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