Controlled hypothermia in post-resuscitation management: what is so cool about it?

Survivors of successful resuscitated cardiac arrest have a high incidence of severe neurological deficits. The pathophysiology of cerebral injury is thought to be multifactorial, and therapeutic mild hypothermia is one of the strategies that have been shown to minimise this complication. In this article, we outline the theoretical basis for this strategy as well as the clinical evidence to support current practice guidelines advocating its use. We also review the technical aspects of implementing hypothermia after resuscitation as well as the potential side effects. Finally, unresolved issues are discussed as we outline the ongoing prospective clinical trial underway in Singapore in order to evaluate its safety and efficacy in our local population. We advocate further research into this topic, as it has great potential to improve the outcomes of comatose resuscitated patients of cardiac arrest.