ERC-ESICM guidelines on temperature control after cardiac arrest in adults

Abstract

The aim of these guidelines is to provide evidence-based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research. The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 h. There was insufficient evidence to recommend for or against temperature control at 32-36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.

Simulation-based assessment of trainee’s performance in post-cardiac arrest resuscitation

“…The Targeted Temperature Management 2 trial results may further laissez-fair attitudes regarding temperature management, despite guideline updates suggesting active temperature management to prevent temperatures > 37.7 °C. 40 …”

“Impact of age on management and prognosis of resuscitated sudden cardiac death patients”

“…TC is considered an effective therapy to improve neurological outcomes in patients with a SCD [35] . A recent update in the current guidelines on temperature control after cardiac arrest in adults [36] recommend actively preventing fever instead of temperature control at 32–36 °C in these patients. In our study, we found that in the elderly patients TC at 33 °C was less performed than in the younger group.…”

Manipulating temperature: devices for targeted temperature management (TTM) in brain injury

“…Recent guidelines on post-resuscitation care have recommended actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 h in patients who remain unconscious after cardiac arrest [5]; these guidelines were mainly driven by a recent randomized trial of 1850 out-of-hospital cardiac arrest survivors, which showed similar outcome between those treated with TTM at 33 °C and those treated when body temperature exceeded 37.7 °C [6]. In this study, surface cooling devices and intravascular methods were used in both groups to achieve target temperatures; as such, nearly 50% of patients in the 37.7 °C group required such devices.…”