Temperature control and fluid management after sudden cardiac arrest

Bernd W. Böttiger, MD, is a professor in the Department of Anesthesiology and Intensive Care Medicine at the University of Cologne, Germany.

What is the recommended strategy of temperature control and fluid management in patients after sudden cardiac arrest (SCA)?

Temperature control is urgently needed. Patients following out-of-hospital cardiac arrest usually come in the hospital with a temperature of ~35, 35.5 degrees Celsius and there is a huge debate whether they should be cooled further or whether normothermia is enough.

We have data, and the meta-analysis will appear soon as a Cochrane review, [showing] that cooling is beneficial in these patients. We are cooling adult patients for at least 24 hours to 33 degrees Celsius. Children may profit from a longer duration of cooling, up to 72 hours. And we need to avoid fever for at least 72 hours in the postresuscitation period.

With regard to fluid management, we use the usual recommendations for fluid management in intensive care unit (ICU) patients. So there are no special recommendations for cardiac arrest patients. Blood pressure levels should be normal and that is all you need.