Emerg Med J 30:91-100 doi:10.1136/emermed-2012-201120
  • Review

Safety profile and outcome of mild therapeutic hypothermia in patients following cardiac arrest: systematic review and meta-analysis

  1. Chaomin Wan1,3
  1. 1Department of Paediatrics, West China Second Hospital, Sichuan University, Chengdu, China
  2. 2Department of Paediatrics, The Medical Center of Dujiangyan, Chengdu, China
  3. 3The Chinese Cochrane Center, Chengdu, China
  1. Correspondence to Dr Chaomin Wan, Department of Paediatrics, West China Second Hospital, West China Medical Center, Sichuan University, No. 20, Section 3, Renmin Nanlu, Chengdu 610041, Sichuan Province, P. R. China; wcm0220{at}
  1. Contributors GX contributed to the conception and design of the study; performed acquisition, analysis and interpretation of the data; and drafted the manuscript. QG contributed to the conception and design of this study, performed acquisition and analysis of the data and helped draft the manuscript. MS contributed to the analysis and interpretation of the data and helped draft the manuscript. XX contributed to the analysis and interpretation of the data and revised the manuscript for important intellectual content. JD, YZ and CW contributed to the conception and design of the study, interpretation of the data, and revision of the manuscript. All authors gave their approval of the final version of the manuscript for publication.

  • Accepted 3 May 2012
  • Published Online First 3 June 2012


Evidence has shown that mild therapeutic hypothermia (MTH) could improve survival and neurological outcome in patients following cardiac arrest. But this therapy may cause some adverse effects. The authors sought to take a systematic approach to describe the safety aspects and outcome of MTH following cardiac arrest to help clinical practice. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, BIOSIS Previews and were searched up to June 2011. Bibliographies of relevant studies were also reviewed. Comparative studies reporting the mortality or any other studies reporting any kind of adverse events in patients undergoing MTH after cardiac arrest and published in English were included. Of 1742 abstracts, 63 studies were included. Most adverse events potentially associated with therapeutic hypothermia were not significantly different between the hypothermia therapy and the normothermia groups. No significant difference was found in the inhospital mortality, bleeding, pneumonia and bradycardia events between surface and endovascular-cooled groups in this study. Cooling device-related adverse events were generally mild. Serious adverse events potentially attributable to therapeutic hypothermia were seldom reported. MTH was associated with reduced inhospital mortality, mortality at 1 month and at 6 months. Evidence about the safety of MTH in children has been limited. These results suggest that while it may result in some adverse events, MTH is generally safe in patients following cardiac arrest and could improve the short-term and long-term survival of comatose patients after cardiac arrest. But awareness of these adverse events should be kept in mind in clinical practice.


  • Funding This work was partly supported by an academic grant from Program for Changjiang Scholars and Innovative Research Team in University (registration number IRT0935).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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