[Mild therapeutic hypothermia after cardiac arrest through continuous dialysis]

Mild therapeutic hypothermia (32-34 degrees C) after resuscitation from cardiac arrest to protect the brain against global ischaemia was first described in two independent randomized controlled studies in 2002. This manuscript describes a method to induce and maintain a target temperature of 32-33 degrees C after cardiac arrest for 24 hours with continuous renal replacement therapy (CRRT).

Intravenous infusion of 30 ml/kg of normal saline 4 degrees C over 30 minutes was immediately started if such treatment had not been initiated upon arrival to the unit. Continuous venovenous haemofiltration (CVVH) was initiated and mild therapeutic hypothermia was maintained for 24 hours. The patient's core temperature was subsequently increased at a rate of 0.5-1.0 degrees C per hour.

Over a two-year period, 33 patients were treated with mild therapeutic hypothermia. The median time from the patient's arrival to the intensive care unit and the achievement of a temperature between 32 degrees C and 34 degrees C was 4.2 hours, and the time to established CRRT was 1.7 hours. The median temperature during the treatment was 33.2 degrees C, and it was maintained for a median period of 24.5 hours. Passive rewarming had a median duration of 5 hours. The only complication was bradycardia which did not cause treatment changes. Eleven (39%) patients had a favorable neurological outcome.

The described CRRT cooling method is a useful method for reaching and maintaining the target temperature. The method is especially suitably for intensive care units that use CRRT on a daily basis for patients with acute renal failure.