• Michael A Gillies, Rosalie Pratt, Craig Whiteley, Jamie Borg, Richard J Beale, and Shane M Tibby.
• Department of Intensive Care, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom. michael.gillies@nhs.net
• Resuscitation. 2010 Sep 1;81(9):1117-22.

ObjectivesTherapeutic hypothermia (32-34 degrees C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome.DesignRetrospective cohort study.SettingThirty-bed teaching hospital intensive care unit (ICU).PatientsAll patients (n=83) undergoing therapeutic hypothermia following cardiac arrest over a 2.5-year period. The mean age was 61+/-16 years; 88% of arrests occurred out of hospital, and 64% were ventricular fibrillation/tachycardia.InterventionsTherapeutic hypothermia was initiated in the ICU using iced Hartmann's solution, followed by either surface (n=41) or endovascular (n=42) cooling; choice of technique was based upon endovascular device availability. The target temperature was 32-34 degrees C for 12-24 h, followed by rewarming at a rate of 0.25 degrees Ch(-1).Measurements And Main ResultsEndovascular cooling provided a longer time within the target temperature range (p=0.02), less temperature fluctuation (p=0.003), better control during rewarming (0.04), and a lower 48-h temperature load (p=0.008). Endovascular cooling also produced less cooling-associated complications in terms of both overcooling (p=0.05) and failure to reach the target temperature (p=0.04). After adjustment for known confounders, there were no differences in outcome between the groups in terms of ICU or hospital mortality, ventilator free days and neurological outcome.ConclusionEndovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial.Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

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