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The 2013 ILCOR and 2010 American Heart Association guidelines support the use of cooling following resuscitation from cardiac arrest. [1] [7] These recommendations were largely based on two trials from 2002 which showed improved survival and brain function when cooled to 32–34 °C (90–93 °F) after cardiac arrest.
In the 1980s, the use of hypothermia on dogs after cardiac arrest demonstrated positive outcomes, including neurological status and survival. In 2005, the American Heart Association implemented recommendations and guidelines for mild hypothermia in post-resuscitation support after cardiac arrest with return of spontaneous circulation. [2]
Regulatory approval is complicated by the fact that victims of trauma and cardiac arrest are incapacitated and therefore unable to personally consent to experimental treatment; therefore stringent "community consent" guidelines must be fulfilled in order to gain approval for the experimental EPR operation. [7]
Current international guidelines suggest cooling adults after cardiac arrest using targeted temperature management (TTM) with the goal of improving neurological outcomes. [123] The process involves cooling for a 24-hour period, with a target temperature of 32–36 °C (90–97 °F), followed by gradual rewarming over the next 12 to 24 hrs.
Before cardiac arrest, the body is in a state of homeostasis. Arterial blood circulates appropriately through the body, supplying oxygen to tissues while the venous blood collects metabolic waste products to be utilized elsewhere and/or eliminated from the body. However, during cardiac arrest, the body is in circulatory and pulmonary arrest ...
Humans had survived cooling to 9 °C, and circulatory arrest of 45 minutes, using external cooling only. [20] However, reaching such low temperatures by external cooling was difficult and hazardous. At temperatures below 24 °C, the human heart is prone to fibrillation and stopping. [21]
Cooling treatment alone has permitted recovery after 17 minutes of clinical death at normal temperature, but with brain injury. [17] Under laboratory conditions at normal body temperature, the longest period of clinical death of a cat (after complete circulatory arrest) survived with eventual return of brain function is one hour. [18] [19]
The median time between initiation of cooling and hospital admission was 28 minutes. No side effects related to the hypothermia cap were observed. The study concluded that "prehospital use of hypothermia caps is a safe and effective procedure to start therapeutic hypothermia after cardiac arrest.