Hart, Lindsay and Newton, Paul ORCID: 0000-0002-8525-6763 (2017) Therapeutic hypothermia in cardiac arrest: a literature review. Journal of Paramedic Practice, 9 (3). pp. 126-131. ISSN 2041-9457

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Abstract

Therapeutic hypothermia (TH) following cardiac arrest is commonplace in many hospitals and intensive care units around the globe as this treatment is thought to improve survival rates and offer neuroprotective benefits. However, its use in the pre-hospital arena is still uncertain with conflicting or little evidence to support the timing, mode of delivery or potential benefit for the patient. The objective of this literature review is to collect and consider evidence and address these uncertainties with a view to offering recommendations for practice.

Methods:
A systematic search was undertaken of 2 databases – EBSCOhost and Pubmed – using a Boolean search strategy. This literature review also included hand searched articles to ensure that a full and comprehensive scope of evidence was collated and included.
Papers were included if they met the following inclusion criteria:
• Studies between 2005 – 2014
• Full text
• English language
• Human subjects
• Pre – hospital studies.
Papers were excluded if they met the following criteria:
• Non – human subjects
• In – hospital studies
• Trauma
• Children
• Studies prior to 2005.
In – hospital studies were not included in this review due to the focus being specifically around pre-hospital care. It was also taken into consideration that individual hospitals would potentially have different specialities within them and also differing guidelines and protocols surrounding the implementation of TH.

Results:
Three specific areas of TH were analysed – the implementation of TH during the cardiac arrest, the mode of initiating TH – either by cooling pads, by using RhinoChill or by infusion of cold fluids - and whether there were clear neurological and survival benefits for the patient.
The results from the studies analysed were unable to provide clear evidence into the benefits of the implementation of intra-arrest TH, although there was some evidence to suggest that one subgroup that received early CPR alongside early TH had improved survival outcomes. In regards to the mode of instigating TH, cooling efficacy was proved in all methods evaluated, although each method had some potential negative outcomes associated with its usage. The final area of analysis showed conflicting evidence around potential survival and neurological outcomes for the patient. Two of the three papers could not support claims that TH improved survival to discharge or improved neurological status, whilst the third paper noted a higher instance of favourable neurological outcomes.

Conclusions:
From the literature reviewed, there is no unanimous evidence that prehospital TH improves patient survival or neurological outcomes. It is clear that all of the different modes of initiating TH that were evaluated were all effective in reducing patient temperature on arrival at hospital.

Item Type:	Article
Uncontrolled Keywords:	Pre-hospital; Therapeutic hypothermia; Cardiac arrest; Adult
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Health Sciences (HEA) Faculty of Education, Health & Human Sciences > Health & Society Research Group
Last Modified:	27 Mar 2018 14:54
URI:	http://gala.gre.ac.uk/id/eprint/16435

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