Temperature control to improve neurological outcomes after cardiac arrest
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1 Draft recommendations
1.1 Temperature control to prevent fever (normothermia), to improve neurological outcomes after cardiac arrest, should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
1.2 Temperature control to induce therapeutic hypothermia, to improve neurological outcomes after cardiac arrest, should be used only in research. Find out what only in research means on the NICE interventional procedures guidance page.
1.3 Clinicians wanting to use temperature control to prevent fever (normothermia), to improve neurological outcomes after cardiac arrest, should:
Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
1.4 Healthcare organisations using temperature control to prevent fever (normothermia), to improve neurological outcomes after cardiac arrest, should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
1.5 Further research into inducing therapeutic hypothermia, to improve neurological outcomes after cardiac arrest, should be in the form of randomised controlled trials which should include patient selection, timing of intervention, degree and duration of temperature control, neurological outcomes and survival.
Why the committee made these recommendations
Temperature control to prevent fever (normothermia)
Clinical trial evidence suggests that there may be less neurological problems (brain injury) after cardiac arrest if core body temperature is kept within its normal range (normothermia). But it is unclear if this is directly related to the procedure.
There are no major safety concerns with normothermia. But, overall, there is not enough good quality evidence on its efficacy. So, it should only be used with special arrangements.
Temperature control to induce therapeutic hypothermia
Clinical trial evidence suggests that there is no benefit from cooling the body's core temperature (therapeutic hypothermia) after cardiac arrest. But, in these trials, the procedure was often delayed. So, the importance of how long after cardiac arrest cooling is done is uncertain.
The evidence on safety shows that people who have had therapeutic hypothermia need sedation and muscle relaxants to prevent and manage shivering, and are more likely to have an abnormal heart rhythm. More research will offer more evidence on safety and long-term outcomes. So, this procedure should be used only in research.
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