Temperature control after cardiac arrest.

Managing temperature is an important part of post-cardiac arrest care. Fever or hyperthermia during the first few days after cardiac arrest is associated with worse outcomes in many studies. Clinical data have not determined any target temperature or duration of temperature management that clearly improves patient outcomes. Current guidelines and recent reviews recommend controlling temperature to prevent hyperthermia. Higher temperatures can lead to secondary brain injury by increasing seizures, brain edema and metabolic demand. Some data suggest that targeting temperature below normal could benefit select patients where this pathology is common. Clinical temperature management should address the physiology of heat balance. Core temperature reflects the heat content of the head and torso, and changes in core temperature result from changes in the balance of heat production and heat loss. Clinical management of patients after cardiac arrest should include measurement of core temperature at accurate sites and monitoring signs of heat production including shivering. Multiple methods can increase or decrease heat loss, including external and internal devices. Heat loss can trigger compensatory reflexes that increase stress and metabolic demand. Therefore, any active temperature management should include specific pharmacotherapy or other interventions to control thermogenesis, especially shivering. More research is required to determine whether individualized temperature management can improve outcomes.

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Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Dr. Elmer receives research funding from the National Institutes of Health to study brain recovery after cardiac arrest including evaluation of temperature management (R01NS124642; R01NS119825, K23NS097692). Dr. Callaway receives research funding from the National Institutes of Health to study emergency treatments including recovery after cardiac arrest and temperature management (U24NS100659; U24NS100656). Dr. Callaway and Dr. Elmer are both members of the Editorial Board of Resuscitation.]