| Abstract [eng] |
This thesis reviews the current evidence of the active temperature control used during the post-resuscitation care of comatose survivors of cardiac arrest. The review includes the current, up-to-date literature with relevant randomised controlled trials, meta-analyses, and systematic reviews. Findings include that currently, there are many studies on active temperature control, investigating the neurological outcome and survival of cardiac arrest patients, which have controversial results regarding the target temperature, type and time of the start of management, duration, methods for cooling, and post-management care. Such differences appear due to the limitations and involvement of many internal and external factors in the survivors’ outcomes, making the studies’ design and analysis challenging. Because of that, present-day recommendations for temperature control are based on low or moderate-level evidence. However, this review concludes that active temperature control, regardless of the target temperature chosen, results in a more favourable neurologic outcome. Currently, international guidelines recommend temperature control with either hypothermia (32.0–35.9 °C) or normothermia (36.0–37.5 °C), along with active fever prevention (fever defined as temperature > 37.7°C), to improve neurologic outcomes in comatose survivors of cardiac arrest. The population of cardiac arrest survivors is heterogeneous; it can be suggested that different temperature targets may have beneficial or adverse effects on specific groups. This study highlights the importance of clinicians having an individual approach to temperature management in post-resuscitation care for each patient rather than rejecting temperature control with hypothermia or normothermia. It also indicates the need for future researchers to analyse existing data and appropriately design future randomised control trials that exclude the problems of the previous trials, such as inconsistent patient selection criteria and inadequate active temperature control management. |
