Complications of therapeutic hypothermia following cardiac arrest

Randomized clinical trials and observational studies have shown that therapeutic hypothermia improves neurologic outcomes and survival in patients following cardiac arrest [1-3]. As the benefit is impressive, with the number needed to treat as low as six patients, therapeutic hypothermia should be applied to more and more patients [4]. At the same time, therapeutic hypothermia is a complex and expensive therapy requiring appropriate equipment, trained personnel, and close patient monitoring. A systematic approach to coordinate care at multiple levels is required for proper patient selection, effective implementation of therapy, and monitoring for possible complications. In our institution, we use a unified pathway-based approach to therapeutic hypothermia [5]. The pathway outlines patient management in a stepwise manner: from the field through the emergency department into the cardiac catheterization laboratory and to the critical care unit (step 1); induced invasive hypothermia protocol in the critical care unit (step 2); and management following the re-warming phase including decisions for future care based on neurologic outcome (step 3). Figure 8.1 shows the pathway for the management of the survivors of out-of-hospital cardiac arrest as implemented at St Luke's Roosevelt Hospital Center, New York. The current chapter focuses on recognition and management of potential complications of hypothermia.