Timing of Cooling and Rewarming

The ideal time to initiate hypothermia post-ROSC has not yet been determined, but its benefits could be maximized if it is initiated as soon as possible after ROSC. Despite a delay of 4 to 6 hours, hypothermia still provides benefit. In the European study, the interval between ROSC and attainment of target temperature had an interquartile range of 4 to 16 hours (8,10,55).

Rewarming to normothermia should be undertaken slowly to avoid worsening of neurologic injury, which has been associated with rewarming posthypothermia (56,57). The European study rewarmed patients passively over 8 hours after 24 hours of hypothermia, whereas the Australian study reported active rewarming for 6 hours at 18 hours of ROSC (8,9). The ILCOR recommended that emphasis be placed on research to determine optimal duration of therapeutic hypothermia, optimum target temperature, and rates of cooling and rewarming.

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