Authors' objectives:

VHA’s TAAG asked TAP for a review of the literature as support for use of hypothermia after cardiac arrest, initially in 2008 and again in 2010. TAP approached its charge through available systematic reviews, guidelines or technology assessments based on such reviews, and economic evaluations using high quality primary studies or reviews as sources of effectiveness data. This document will refer collectively to these synthesis publication types as “reviews”. We then updated review searches to the present to confirm the presence or absence of subsequently review-eligible studies that would change review conclusions.

Authors' recommendations: The RCT and meta-analytic evidence supporting hypothermia for comatose survivors of resuscitation from ventricular fibrillation cardiac arrest is characterized by some writers as “compelling”. Others (SBU, 2006; CEDIT, 2004; ANZHSN, 2005; all in Table 1) are more circumspect, citing heterogeneity among trials, relatively small numbers, technical or organizational impediments to wide implementation, and the need for continuing research.While agreeing on the relatively small body of eligible research and need for more studies to close knowledge gaps, the most recent high-quality review [Arrich (Cochrane; 2009) in Appendix Table 1] finds available evidence consistent for positive effects of hypothermia on survival and neurologic outcome. In this context, we note the addition of hypothermia to complex interventions for improvement of resuscitation protocols (Appendix Table 4) and the corresponding difficulties of isolating its effects from those of other interventions.Of particular note, studies covered here provide evidence that simple “low-tech” methods (cold IV fluids, blankets, ice packs) for inducing hypothermia are effective: Arrich (2009) pooled comparable studies using standard cooling, and the single inadequate-quality trial comparing outcomes with simple methods directly to one device (Heard, 2010; Appendix Table 2.) found no significant differences.

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/HypothermiaCardiacArrest2010.pdf

Year Published: 2010

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: VA Technology Assessment Program (VATAP)