Therapeutic Hypothermia Research Review

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"The proportion of cardiac arrest patients treated with TH had increased from 4% in 2002 to 28% in 2005. The incidence of cardiac arrest patients admitted to ICUs was 15/100,000 inhabitants/year. The use of TH varied in different areas of the country from 3.4 to 5.0/100,000 inhabitants/year. In-hospital mortality of TH patients was 32.7% and increased from 13.2% in age group" (Oksanen 2007: 866). In the Oksanen study, younger patients treated with TH had a significantly better survival rate: the larger numbers in this study and the meticulous demographic data allowed for a more refined conclusion than some other TH studies. However, this study merely demonstrated a correlation between the increased use of TH and improved outcome rates of cardiac patients at the hospitals in question, rather than demonstrated a clear cause-and-effect relationship.

Literature reviews of TH studies on wider populations of patients have been less promising. Sayre et al. (2010) in the Ohio Department of Public Safety study "Effect of pre-hospital therapeutic hypothermia on neurologic outcome following sudden cardiac arrest" conducted a review of 450 resuscitations in medical literature. Sayre et al. (2010) found that TH caused neither a negative-nor a positive-improvement in patient survival or neurological improvement. The one positive finding for advocates of the technique is that the Sayre study does validate TH safety, a finding also confirmed by an implementation study by Busch (2006) "Rapid implementation of therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors." This study found that a simple, external cooling protocol could be implemented easily "overnight in any system already treating post-resuscitation patients" and had an 89% success rate in reaching optimal temperature-however, only 27 patients made up the study (Busch 2006: 1277).

A more recent, 2009 study by Castren (2009) "Scandinavian clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest" found the TH technique ineffective because even experienced physicians were unaware of "optimal target temperature, duration of cooling and rewarming time" and were only able "to predict the clinical outcome correctly in only 52% of the patients" (Castren 2009: 280). Supporters of the therapy admit that a lack of knowledge and training has made widespread implementation of TH problematic. In one Canadian study by Kenneday, J. et al. (2010),"The…[continue]

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