Hipotermia terapéutica: ¿lo dejamos?

Abstract

Current international guidelines recommend therapeutic hypothermia for patients who have survived a witnessed cardiac arrest to minimize neurological damage due to postischemic reperfusion. This recommendation is based mainly on the results of two randomized, controlled trials that included 352 patients and on supporting evidence from the field of neonatal asphyxia that also demonstrated the neuroprotective effect of hypothermia. However, the use of hypothermia in the context of a cardiac arrest has been called into question in the wake of a recently published randomized trial that included 939 patients and which found that hypothermia at 33 °C offered no benefits over maintaining a temperature of 36 °C. Moreover, another recent study has questioned the usefulness of starting hypothermia early in the prehospital phase. This article contains a review of the evidence available on the use of hypothermia, areas of uncertainty and strategies for using the technique. It concludes that there is sufficient evidence to support the continued use of hypothermia in the majority of patients who suffer a cardiac arrest and have a heart rhythm susceptible to defibrillation, pending the results of new studies using a range of target temperatures (32-36 °C) and treatment durations.