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Comment & Response |

Therapeutic Hypothermia and Targeted Temperature Management After Cardiac Arrest—Reply

Neal E. Little, MD1; Eva L. Feldman, MD, PhD2
[+] Author Affiliations
1Emergency Physicians Medical Group PC, Ann Arbor, Michigan
2Department of Neurology, University of Michigan, Ann Arbor
JAMA Neurol. 2014;71(12):1578. doi:10.1001/jamaneurol.2014.3128.
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In Reply We are pleased to respond to Freeman et al in the letter concerning our Viewpoint1 titled “Therapeutic Hypothermia After Cardiac Arrest Without Return of Consciousness: Skating on Thin Ice.” We concluded our Viewpoint with a call to commit resources to rigorously establishing the value of a novel therapy before its premature adoption. The 2 randomized clinical trials referenced by Freeman et al and analyzed by us in the Viewpoint had major shortcomings yet serve as the basis for the widespread use of therapeutic hypothermia (TH). As detailed in the Viewpoint, the International Liaison Committee on Resuscitation had only a thin evidence base for its recommendation. Widespread adoption of treatment strategies where the patient has no possibility of input, such as TH, demand more rigorous evidence than those where shared decision making can take place. In the absence of patient autonomy, we believe clinicians must continue to advocate for solid evidence of effectiveness.

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December 1, 2014
William D. Freeman, MD; Lioudmila V. Karnatovskaia, MD; Tyler F. Vadeboncoeur, MD
1Department of Neurology, Mayo Clinic, Jacksonville, Florida2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida3Department of Critical Care, Mayo Clinic, Jacksonville, Florida
4Department of Critical Care at Mayo Clinic, Rochester, Minnesota
5Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida
JAMA Neurol. 2014;71(12):1577-1578. doi:10.1001/jamaneurol.2014.3125.
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