Interventional procedure overview of temperature control to improve neurological outcomes after cardiac arrest
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What the procedure involves
After cardiac arrest, people in a coma who have return of spontaneous circulation (ROSC) can have their core body temperature actively controlled. This is done to prevent fever (by maintaining a normal temperature of between 36.5°C and 37.5°C), or to induce therapeutic hypothermia (by cooling to a core temperature typically between 32.0°C and 36.0°C).
The aim is to reduce brain injury and improve neurological outcomes. The exact mechanism by which cooling may protect against brain injury is unknown. Possible mechanisms include reductions in metabolic demand, release of excitatory neurotransmitters and inflammation after ischaemia.
Temperature control is done using surface techniques (for example, heat exchange cooling pads, cooling blankets and ice packs), or internal techniques (for example, an endovascular cooling device). Core body temperature is monitored using a temperature probe (such as a bladder, rectal or nasopharyngeal temperature probe) and is controlled to a preset point determined by the clinician.
If therapeutic hypothermia is induced, controlled rewarming is usually done over several hours. In addition, people who have had cardiac arrest generally have standard critical care measures and may require intravenous sedation and muscle relaxants, to prevent shivering.
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