[Prehospital cardiac arrest. Therapeutic hypothermia in adults].

Therapeutic hypothermia is one of the few advances in recent years that has improved survival and neurological outcome of survivors of cardiac arrest. Therapeutic hypothermia is part of current guidelines and, therefore, should be part of the routine procedure in postresuscitation care of patients still comatose after primarily successful resuscitation. Early induction of hypothermia may be achieved even in the prehospital setting with different cooling techniques which, however, are less suitable to maintain a constant temperature and additionally do not allow precisely controlled re-warming. To achieve the goal of a target temperature of 32-34°C for 12-24 h, controlled feedback systems are more reliable and also can be used for patients during percutaneous coronary intervention. The optimal time point to start cooling is not well defined, even if theoretical considerations and animal experiments are in favor of beginning early. Another question is whether therapeutic hypothermia is of benefit for patients with cardiac arrest due to asystole and pulseless electrical activity in contrast to patients with ventricular fibrillation where it is of proven value.