2007 Dickinson W. Richards Memorial Lecture—To cool or not to cool . . . ?
In industrial countries, 36 to 128 per 100 000 inhabitants per year die of sudden cardiac arrest. In these cases, resuscitation efforts are initiated in 34% to 86%, and return of spontaneous circulation as well as admission to a hospital can be achieved in 17% to 49%. Almost 80% of patients who initially survive present with coma lasting more than 1 hour, and fewer than 2% to 4% survive neurologically intact. This has not changed over the past 50 years! Therefore, our current therapeutic concepts, which concentrate mainly on external support of circulation and respiration with additional drug and electrical therapy during cardiac arrest, have to be modified. The chain-of-survival concept must be extended to strategies before and after cardiac arrest. Much more attention has to be given to educating our children in the “101” of life-supporting first aid and our intensivists in the “101” of postresuscitative care to successfully close the life cycle. Already, evolving concepts are on the horizon to win the fight against the irreversible injury to the brain and heart, which begins within minutes after global ischemia. Resuscitative mild hypothermia is already used clinically and improves outcome in comatose survivors after resuscitation from out-of-hospital cardiac arrest. Preservative hypothermia, ie, induction of deep to profound hypothermia during cardiac arrest before reperfusion (Emergency Preservation and Resuscitation; EPR), might be a novel concept to further improve outcome after normovolemic cardiac arrest. Let’s start to find alternative and innovative answers to Hamlet’s question to substantially improve outcome after cardiac arrest.