'Cooling' treatment could save lives and reduce brain damage
More people who suffer cardiac arrests could soon be offered a cooling treatment to reduce the risks of them dying or becoming severely brain damaged. This comes as new NICE guidance advises doctors that the treatment is safe and works well enough for routine use in certain patients.
“Therapeutic hypothermia” is a procedure used in some critical care units for people who have just been resuscitated following cardiac arrest due to a heart attack or other trauma. The treatment involves lowering a person's body temperature to 32-34°C while unconscious, using a blanket or mattress filled with air or fluid, or a special cap. The aim is to cool the person's brain and slow down the rate of cell damage.
Up until now, there have been significant uncertainties among doctors about the procedure's risks and its potential to reduce brain damage and save lives, compared to standard intensive care treatments. This has meant while certain hospitals in the NHS may be offering this to some of their critically ill patients, others may not be considering it at all.
The new guidance from the National Institute for Health and Care Excellence (NICE) advises that healthcare professionals could consider therapeutic hypothermia as a treatment option for people who are at risk of brain injury after cardiac arrest, under their hospital's usual arrangements for clinical audit/research, governance and consent.
Professor Bruce Campbell, Chair of the Interventional Procedures Advisory Committee which produced the guidance for NICE said: “The evidence shows that controlled cooling of selected patients who have suffered cardiac arrest can increase their chances of survival. The therapy can also reduce the risk of severe brain damage, which can occur when blood flow to the brain is disturbed.
“While the outcomes of therapeutic hypothermia seem to look promising, we still need to find out more about precisely which patients are most likely to benefit from its use. This is why we are encouraging further research in this area.”
The NICE guidance does not advise whether or not the procedure should be funded - these decisions are made locally.
For more information call the NICE press office on 0845 003 7782 or out of hours on 0777 558 3813.
Notes to Editors
About the NICE guidance
1. Cardiac arrest (when the heart suddenly stops beating) leads to loss of consciousness and death unless emergency resuscitation is given and the heart restarted. Some people may develop neurological problems because of the lack of oxygen to the brain before the heart is restarted.
2. “Therapeutic hypothermia” involves cooling the unconscious person's body temperature from 37°C to between 32°C and 34°C soon after the cardiac arrest and for 12-24 hours afterwards. The idea is to cool the brain in the hope of slowing down and limiting the processes that cause brain damage. The person's body temperature is monitored throughout the procedure. As well as cooling, patients will be sedated and given muscle relaxants (to prevent shivering). After the cooling period, the person is warmed up gradually until their temperature has returned to normal.
3. The NICE guidance states that “Current evidence on the safety and efficacy of therapeutic hypothermia following cardiac arrest is adequate to support the use of this procedure providing that normal arrangements are in place for clinical governance, audit and consent.” View the Therapeutic hypothermia following cardiac arrest for further information. A patient booklet is also available.
About Interventional Procedures guidance
1. NICE's Interventional Procedures guidance applies to NHS healthcare settings in England, Northern Ireland, Scotland and Wales. The guidance makes recommendations on the safety of a procedure and how well it works.
2. Interventional Procedures guidance does not cover whether or not the NHS should fund a procedure. Decisions about funding are taken by local NHS bodies after considering how well the procedure works and whether it represents value for money for the NHS.
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
- Public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- Health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- Clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
3. NICE produces standards for patient care:
- Quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 23 March 2011