Out-of-hospital cardiac arrest in adults: lowering body temperature.

Introduction: Post-resuscitation care after return of spontaneous circulation is critical to improving patient outcomes in sudden cardiac death. Therapeutic hypothermia has been a mainstay of treatment after successful cardiopulmonary resuscitation in the setting of ventricular fibrillation or pulseless ventricular tachycardia.

Methods and outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of lowering body temperature for comatose survivors of out-of-hospital cardiac arrest associated with ventricular tachycardia or ventricular fibrillation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

Results: At this update, searching of electronic databases retrieved 222 studies. After deduplication and removal of conference abstracts, 114 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 89 studies and the further review of 25 full publications. Of the 25 full articles evaluated, one systematic review included in a previous version was updated and three RCTs were added at this update. We performed a GRADE evaluation for five PICO combinations.

Conclusions: In this systematic overview, we categorised the efficacy for three interventions based on information about the effectiveness and safety of therapeutic hypothermia, different lower body temperatures, and different durations of lower body temperatures.