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    Temperature control to improve neurological outcomes after cardiac arrest

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    1 Draft recommendations

    Temperature control to prevent fever

    1.1 Temperature control to prevent fever, to improve neurological outcomes after cardiac arrest may be used if standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.

    1.2 For auditing the outcomes of this 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).

    Temperature control to induce therapeutic hypothermia

    1.3 Temperature control to induce therapeutic hypothermia (a temperature of less than 36°C), 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.

    1.4 Further research should be in the form of randomised controlled trials, and should report:

    • patient selection

    • timing of the intervention

    • degree and duration of temperature control

    • neurological outcomes

    • survival.

    Why the committee made these recommendations

    Clinical trial evidence suggests that, if core body temperature is controlled to prevent fever after cardiac arrest, there may be improved neurological outcomes (less brain injury). There are no safety concerns with fever prevention. So, it can be used with standard arrangements. But more research is needed on whether the improved neurological outcomes are directly related to the procedure.

    Some clinical trial evidence suggests that there is less brain injury when the body's core temperature is cooled to below 36°C (therapeutic hypothermia) after cardiac arrest. But other clinical trial evidence suggests that there is no reduction in brain injury. In some trials, the procedure was delayed. So, the importance of how long after cardiac arrest cooling is started is uncertain.

    Evidence on the safety of therapeutic hypothermia suggests that it is potentially harmful. People who have this procedure are also more likely to have an abnormal heart rhythm. More research is needed on safety and long-term outcomes of therapeutic hypothermia after cardiac arrest, so it should be used only in research.