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Warmuth, M. and Stumpner, T. (2012): Therapeutic hypothermia (TH). Decision Support Document 63.

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Abstract

During mild therapeutic hypothermia the body temperature is lowered to around 32-34°C. Presently, mild therapeutic hypothermia is recommended for patients following cardiac arrest. It aims at improving neurological outcomes and reducing mortality. This report gives an overview of the best available evidence of therapeutic hypothermia for eleven different indications in adults: cardiac arrest, stroke, traumatic brain injury, spinal cord injury, cardiogenic shock, refractory fever, sepsis, meningitis/meningoencephalitis, convulsive status epilepticus, acute liver failure and acute renal failure.

In addition to a systematic literature search in several databases, we conducted an unsystematic hand search as well as a search for on-going or recently finished clinical studies in three study registries. Two researchers independently selected the literature and included or excluded selected studies. One review author extracted the data and a second author controlled the extracted data regarding completeness and accuracy. In cases of disagreement, we reached consensus through discussion or by involving a third person.

In total, we identified 14 studies concerning ten indications, four of which were Cochrane Reviews, one was a randomised controlled trial, one was a non-randomised controlled trial, seven were case-series and one was a case report. We were not able to identify any study regarding the indication acute renal failure. The present overview of evidence indicates that therapeutic hypothermia is efficacious and safe in one out of eleven indications (cardiac arrest). In addition, it appears to be safe in stroke patients, however, the efficacy for this indication remains to be shown. For all other indications, both the efficacy and safety remain to be proven.

In summary, therapeutic hypothermia represents a dynamic field of research. Hence, the evidence base may change for several evaluated indications (stroke, traumatic brain injury, sepsis, status epilepticus) in the near future. The routine use of therapeutic hypothermia outside of clinical trials is not recommended.

Item Type:Decision Support Document
Keywords:therapeutic hypothermia induced hypothermia, mild hypothermia, external cooling, internal cooling, invasive cooling, non-invasive cooling
Subjects:WB Practice of medicine > WB 300-962 Therapeutics
WL Nervous system > WL 200-405 Central nervous system. Disorders. Therapeutics > WL 356 Brain ischemia. Stroke
WG Cardiovascular system
WB Practice of medicine > WB 102 Evidence-based medicine
WL Nervous system > WL 200-405 Central nervous system. Disorders. Therapeutics
Language:German
Series Name:Decision Support Document 63
Deposited on:23 Nov 2012 14:12
Last Modified:23 Nov 2012 14:12

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