'Cooling and cathing' the post-resuscitated

Determining priorities for optimal post-resuscitation care is challenging. Cronier and colleagues [1] share their experience with combining routine coronary angiography with induction of mild hypothermia for patients successfully resuscitated from cardiac arrest. Most recognize the value of therapeutic hypothermia in the treatment of the post-cardiac arrest patient [2,3]. But other suggested therapies have limited efficacy data, leaving both the treating physician and medical institutions uncertain about what else to do and how to do it. In a recent issue of Critical Care, Cronier and colleagues share their experience in performing routine coronary angiography and percutaneous intervention (PCI) after successful resuscitation from out-of-hospital cardiac arrest due to ventricular fibrillation [1]. They achieved a 54% survival to discharge rate with 90% of survivors having favorable neurological status in 111 patients who had coronary angiography with or without PCI after being resuscitated from out-of-hospital ventricular fibrillation. About half of all patients had PCI for an angiographically identified culprit lesion suspected of causing their cardiac arrest. Subdividing their study population by age, they found no significant differences in outcome among those less than 75 years of age. The number of patients older than 75 years was too small for meaningful comparison.Mild therapeutic hypothermia was part of their post-resuscitation therapeutic bundle of care and was performed in 86% of all patients. In the remaining patients, therapeutic hypothermia was not performed because of severe hemodynamic instability or moribund status. Target temperature (32 to 34°C) was reached in 81% of patients. These proportions of patients receiving hypothermia and reaching temperature goal compare favorably with other reports [4].Though all patients were considered for coronary angiography regardless of their electrocardiographic findings, those considered 'hemodynamically unstabl