This is Steve Carroll, and you're listening to E.M. Basic Essential Evidence. Today we'll be talking

about the two articles that started the treatment of therapeutic hypothermia for patients who survive

out-of-hospital cardiac arrest. These two articles were published in England Journal of Medicine

in the same issue in February 2002, and they started the era of cooling patients who come in

after cardiac arrest. We'll review both articles and talk about what they mean for our practice

in emergency medicine. As always, his podcast doesn't represent the user opinions of the Department

Defense, the U.S. Army, or the Ford Hood Post Command. The two articles I'll be referencing are titled Mild Therapeutic Hypothermia to Improve

the Neurological Outerotic Arrest and Treatment of Comatose Survivors of Out of Hospital

Cardiac Arrest.

Both studies were published in the New England Journal of Medicine on February 22, 2002,

and the full text of both studies is available

for free at NEJM.org. I'll post links to both articles at DMBASIC.org. So let's talk about these

studies. So these were the first two studies that randomized patients who experienced an out-of-hospital

cardiac rest to either normothermia or hypothermia.

One study was done in Austria and the other was done in Australia.

Both were multi-center studies, meaning that each study enrolled patients at more than one hospital.

This is a strength of this study because it helps even out the effect of treatment differences

between different hospitals instead of focusing on just one center. To be eligible for the study,

you had to be an adult who experienced an out-of-hospital cardiac arrest, who regained sustained

spontaneous circulation, but remain comatose. Also, your initial rhythm for EMS had to be either V-Fib or Pulseless V-TAC,

so those patients with acystole or P-EA as an initial rhythm were excluded. The European study specified

that the cardiac arrest had to be witnessed and not have occurred after the arrival VMS personnel,

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