Prehospital therapeutic hypothermia in cardiac arrest will there ever be evidence 英文参考文献.docVIP

Available online /content/12/2/413 Letter Prehospital therapeutic hypothermia in cardiac arrest: will there ever be evidence? Joerg C Schefold, Christian Storm and Dietrich Hasper Department of Nephrology and Medical Intensive Care Medicine, Charité Universit?tsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany Corresponding author: Joerg C Schefold, schefold@charite.de Published: 9 April 2008 Critical Care 2008, 12:413 (doi:10.1186/cc6844) This article is online at /content/12/2/413 ? 2008 BioMed Central Ltd See related research by Bruel et al., /content/12/2/R31 Bruel and colleagues nicely demonstrate that the infusion of 2 l cold saline during resuscitation is a feasible, effective, and safe measure to induce therapeutic hypothermia in out-of- hospital cardiac arrest [1]. Therapeutic hypothermia was induced in 33 eligible advanced life support patients before primary survival was foreseeable, and was continued in 11 patients after intensive care unit admission. The authors conclude that a large randomised trial should be performed. overall gain of time (typically around 45 min) may be considered marginal against the background of most published data, indicating that target temperatures cannot be reached until about 6 to 8 hours later [2,3]. Given the optimistic view that prehospital cooling increases the number of favourable neurological outcomes from 55% [4] to 60%, about 750 patients would have to be included in a given randomised trial. The design of future trials on therapeutic hypothermia, however, seems challenged by the fact that withholding this treatment in a control arm might be considered unjustifiable from an ethical point of view. In the prehospital setting, such a trial would require a large number of study patients to demonstrate an additional benef