Hyperthermia

Increasing body temperature after CA has been associated with poor neurologic outcome. In a study of patients presenting in the emergency department with CA, a body temperature higher than 37°C within 48 hours after resuscitation was associated with unfavorable functional neurologic recovery. For every degree higher than 37°C, the study reported an incremental increased association with severe disability, coma, or persistent vegetative state, [odds ratio (OR): 2.26; 95% CI: 1.24-4.12] (81). In another study, body temperature of 39°C or higher after resuscitation from CA was associated with brain death (OR: 37.8; 95% CI: 6.72-212.2) (82).

Fevers due to infection must be controlled, and the cause, properly treated. However, in a significant portion of patients, an infectious source for the fever is not identified. The mechanism by which "noninfectious" hyperthermia occurs after CA is still unclear. Occult infection from intestinal ischemia, the systemic translocation of bacteria or toxins (83), and pulmonary aspiration because of lack of airway protective reflexes in coma (84 ) are significant causes of hyperthermia in this subset of patients. Hyperthermia might be related to injuries that affect the anterior hypothalamus (85,86). Hyperthermia accentuates the release of neurotransmitters and free radical activity and promotes excitotoxic injury in global ischemia (39,87,88 ). Therefore, hyperthermia must be avoided during the post-CA period to provide the patient with the best chance of recovery.

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