This past week our Regional Medical Advisory Committee voted unanimously to suspend our prehospital therapeutic hypothermia guidelines in light of two recent studies.
The first, Effect of prehospital induction of mild hypothermia on survival and..., published in the January 2014 Journal of the American Medical Association, showed that while there was no difference in neurologically intact survival between those patients who were cooled prehospitally and those who were cooled in the hospital, those who were cooled prehospitally were more likely to rearrest and more likely to suffer side effects such as pulmonary edema.
The second study, Targeted Temperature Management at 33 degrees C versus 36 degrees C, published in the December 2013 New England Journal of Medicine, showed that there was no difference in survival between those patients who were cooled to 33 degrees Centigrade and those who were kept normothermic at 36 C.
It is now speculated that it was not necessarily cooling patients that was leading to improvements in survival, but keeping them from getting a fever that is likely the reason for better outcomes.
This had mixed reviews on our Facebook page, with some readers questioning the studies and others saying it has been removed from their protocols as well.
What do you think?