1.1
Use temperature control as an option to prevent fever and improve neurological outcomes after cardiac arrest with standard arrangements in place for clinical governance, consent and audit.
Guidance
1 Recommendations
1 Recommendations
To prevent fever
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).
To induce therapeutic hypothermia
1.3
More research is needed on temperature control to induce therapeutic hypothermia (a temperature of less than 36°C) to improve neurological outcomes after cardiac arrest.
1.4
This procedure should only be done as part of a formal research study and a research ethics committee needs to have approved its use.
1.5
More research, in the form of randomised controlled trials, is needed on:
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patient selection
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timing of the intervention
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degree and duration of temperature control
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neurological outcomes
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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.