Prolonged hypothermia for neurological protection

Treatment with mild hypothermia induced after cardiopulmonary resuscitation has become a standard of care, but optimal timing and duration of hypothermia remains unclear. We present a 66-year-old man admitted after an out-of-hospital cardiac arrest. Because of his severe hypoxemia, cardiopulmonary instability, and respiratory acidosis after resuscitation, he was continued on therapeutic hypothermia until his hypoxia resolved. As a result, the patient was kept at the goal hypothermic temperature of 33°C for a total of 48 hours, compared with the usual 24-hour standard, with excellent sustained neurological recovery. This case documents the usefulness of extending hypothermia when applied to severely unstable patients and suggests that a sliding-target approach may be applied on a patient-by-patient basis.